Healthcare Provider Details

I. General information

NPI: 1275675928
Provider Name (Legal Business Name): ZULMA IVELISSE GOMEZ R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 183 BO. HATO KM 1 SAN LORENZO SHOPPING CENTER
SAN LORENZO PR
00754
US

IV. Provider business mailing address

440 VIA CAMPINA HACIENDA SAN JOSE
CAGUAS PR
00727-3098
US

V. Phone/Fax

Practice location:
  • Phone: 787-715-1770
  • Fax: 787-715-1771
Mailing address:
  • Phone: 787-299-0792
  • Fax: 787-715-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4305
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: