Provider Demographics
NPI:1093926941
Name:OSORIO, DORELIS
Entity Type:Individual
Prefix:MRS
First Name:DORELIS
Middle Name:
Last Name:OSORIO
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:STREET 4 ALTURAS DE RIO GRANDE
Mailing Address - Street 2:#E 197
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-556-6121
Mailing Address - Fax:787-876-7751
Practice Address - Street 1:VILLAS DE LOIZA
Practice Address - Street 2:CALLE 1 BLOQUE 1
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-3500
Practice Address - Fax:787-876-7751
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2339183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician