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General NPI Number Information
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NPI Number | 1194505883
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Entity Type | Individual
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Provider Name | LOURDES YAMILKA MATEO
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 333 CALLE 25 NE
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City | SAN JUAN
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State | PR
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Zip | 00920-2531
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Country | US
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Telephone | 787-775-7773
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Fax | 787-775-7773
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Provider Business Mailing Address
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Address Line | COUNTRY CLUB CALLE SAMOA 835
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-662-1394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 010701
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License Number State | PR
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