=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538497730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHIANE ORTIZ GONZALEZ PHARMACY TECHNITIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2009
-----------------------------------------------------
Last Update Date | 11/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AI9 CALLE 1 URB.VILLA DEL CARMEN
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-469-4606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AI9 CALLE 1 URB.VILLA DEL CARMEN
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-469-4606
-----------------------------------------------------
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 | 6912
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------