Healthcare Provider Details

I. General information

NPI: 1013378017
Provider Name (Legal Business Name): JOSE MARCOS BRUNET RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 CALLE RAMOS ANTONINI
PONCE PR
00728-4806
US

IV. Provider business mailing address

PO BOX 8862
PONCE PUERTO RICO
00732
UM

V. Phone/Fax

Practice location:
  • Phone: 787-844-2805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number011055
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: