Provider Demographics
NPI:1003573932
Name:GARCIA - QUINTANA, ELBA MARIA
Entity Type:Individual
Prefix:MISS
First Name:ELBA
Middle Name:MARIA
Last Name:GARCIA - QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CALLE ANTONIO MUNIZ
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2138
Mailing Address - Country:US
Mailing Address - Phone:939-308-2231
Mailing Address - Fax:
Practice Address - Street 1:B7 CALLE TABONUCO STE 301
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3364
Practice Address - Country:US
Practice Address - Phone:787-705-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist