Provider Demographics
NPI:1093451189
Name:AGOSTO, YESENIA (PHT)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:PHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J-23 AVE BETANCES
Mailing Address - Street 2:URB HERMANAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-778-5313
Mailing Address - Fax:
Practice Address - Street 1:J-23 AVE BETANCES
Practice Address - Street 2:URB HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-778-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3010183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician