=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801923545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SELINETH MACHADO TECH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 CALLE SANTA CRUZ STE 101 CALLE SANTA CRUZ
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-870-6018
-----------------------------------------------------
Fax | 787-288-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 CALLE SANTA CRUZ STE 101 CALLE SANTA CRUZ
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-870-6018
-----------------------------------------------------
Fax | 787-288-8111
-----------------------------------------------------
=====================================================
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 | 4195
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------