Healthcare Provider Details

I. General information

NPI: 1295927465
Provider Name (Legal Business Name): MRS. GREISHA PICART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND PONCIANA SUITE 405 CALLE MARINA 9140
PONCE PR
00717-2030
US

IV. Provider business mailing address

PO BOX 10747
PONCE PR
00732-0747
US

V. Phone/Fax

Practice location:
  • Phone: 787-360-8350
  • Fax: 787-840-8645
Mailing address:
  • Phone: 787-360-8350
  • Fax: 787-840-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberAC0706
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: