Provider Demographics
NPI:1043433295
Name:NISTAL, MARITZA
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:NISTAL
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:HC 06 BOX 19876
Mailing Address - Street 2:BO HATO ARRIBA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-817-0468
Mailing Address - Fax:
Practice Address - Street 1:HC 06 BOX 19876
Practice Address - Street 2:BO HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1697183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1697OtherTECNICA DE FARMACIA