Healthcare Provider Details

I. General information

NPI: 1093840548
Provider Name (Legal Business Name): NYDIAN CRESPO PHARM. TECH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO.SABANA HOYOS HC-83 BUZON 6673
VEGA ALTA PR
00692-9710
US

IV. Provider business mailing address

BO. SABANA HOYOS HC-83 BUZON 6673
VEGA ALTA PR
00692-9710
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-1838
  • Fax:
Mailing address:
  • Phone: 787-883-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5072
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: