MEDICARE: DEBBIE SUZANNE DETRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	2244	PR

General Provider Information

NPI Number	:	1922142280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE SUZANNE DETRES

Provider Business Mailing Address
First Line	:	1200 CARR 849
Second Line	:	CONDOMINIO VISTA VERDE APT. F228
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4563
Country	:	US
Telephone Number	:	787-276-3456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 CARR 849
Second Line	:	CONDOMINIO VISTA VERDE APT. F228
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4563
Country	:	US
Telephone Number	:	787-276-3456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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