Provider Demographics
NPI:1053050948
Name:BENNAZAR, MARILIANA
Entity Type:Individual
Prefix:
First Name:MARILIANA
Middle Name:
Last Name:BENNAZAR
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0057
Mailing Address - Country:US
Mailing Address - Phone:787-824-2800
Mailing Address - Fax:
Practice Address - Street 1:44 CALLE DIOSDADO DONES BO COCO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2570
Practice Address - Country:US
Practice Address - Phone:787-824-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004295Other004295