Provider Demographics
NPI:1114283728
Name:SANTOS-ROSARIO, JOMERCY LEANIA
Entity Type:Individual
Prefix:
First Name:JOMERCY
Middle Name:LEANIA
Last Name:SANTOS-ROSARIO
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:LUCERNA APTS,
Mailing Address - Street 2:APT 3-H, ED A-3
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-564-1947
Mailing Address - Fax:
Practice Address - Street 1:LUCERNA APTS,
Practice Address - Street 2:APT 3-H, ED A-3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-564-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8002183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4495630OtherDRIVERS LICENSE