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General NPI Number Information
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NPI Number | 1275703159
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Entity Type | Individual
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Provider Name | BRENDA I GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | COND GOLDEN TOWER # C8 AVE. PONTEZUELA
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City | CAROLINA
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State | PR
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Zip | 00983-1899
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Country | US
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Telephone | 787-752-9955
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Fax |
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Provider Business Mailing Address
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Address Line | CC14 CALLE 29 URB RIO GRANDE STATE
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City | RIO GRANDE
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State | PR
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Zip | 00745-5073
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Country | US
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Telephone | 787-206-0102
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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 | 2120
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License Number State | PR
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