Healthcare Provider Details

I. General information

NPI: 1689790156
Provider Name (Legal Business Name): NERY I MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 KM 62.7 SECTOR CANDELARIA
SABANA HOYOS PR
00688
US

IV. Provider business mailing address

URBANIZACION PASEOS REALES 739 AVENIDA EMPERADOR
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-2440
  • Fax: 787-880-3258
Mailing address:
  • Phone: 787-349-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2261
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: