Provider Demographics
NPI:1053826271
Name:TRAVERSO, KEYLA Z (RPH)
Entity Type:Individual
Prefix:
First Name:KEYLA
Middle Name:Z
Last Name:TRAVERSO
Suffix:
Gender:F
Credentials:RPH
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 784
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0784
Mailing Address - Country:US
Mailing Address - Phone:787-849-1714
Mailing Address - Fax:787-849-1715
Practice Address - Street 1:CARR 2 KM 166.2
Practice Address - Street 2:LAVADERO
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-1714
Practice Address - Fax:787-849-1715
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist