Healthcare Provider Details

I. General information

NPI: 1568372472
Provider Name (Legal Business Name): GABRIEL JOMAR CARRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CALLE RUBI
SAN LORENZO PR
00754-9924
US

IV. Provider business mailing address

118 CALLE RUBI
SAN LORENZO PR
00754-9924
US

V. Phone/Fax

Practice location:
  • Phone: 787-988-4110
  • Fax:
Mailing address:
  • Phone: 787-988-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number17603
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: