Healthcare Provider Details

I. General information

NPI: 1851624829
Provider Name (Legal Business Name): DESARROLLADORA COMERCIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 CALLE SANTA ANA # A BO COCO NUEVO
SALINAS PR
00751-2625
US

IV. Provider business mailing address

PO BOX 1
AGUIRRE PR
00704-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-2617
  • Fax: 787-824-6797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11-F-2747
License Number StatePR

VIII. Authorized Official

Name: MARILIANA BENNAZAR
Title or Position: PRESIDENT
Credential:
Phone: 787-444-2365