Healthcare Provider Details

I. General information

NPI: 1275541260
Provider Name (Legal Business Name): DIMARYS ESCUDERO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 160 KM 4.5 BO ALMIRANTE NORTE
VEGA BAJA PR
00693
US

IV. Provider business mailing address

CALLE LOS MILAGROS #9
CIALES PR
00638
US

V. Phone/Fax

Practice location:
  • Phone: 787-917-0603
  • Fax: 787-917-0688
Mailing address:
  • Phone: 787-599-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5587
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: