=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215146097
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEYDA OLIVERAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 715 AVE PONCE DE LEON
-----------------------------------------------------
City | HATO REY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00917-5032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-2000
-----------------------------------------------------
Fax | 787-771-7788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE 38 BLOQ. 41 #9 VILLA CAROLINA
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 3123
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------