Provider Demographics
NPI:1194846832
Name:DORTA, IRIS VIVIANA (PHARMACY TCHNICIAN)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:VIVIANA
Last Name:DORTA
Suffix:
Gender:F
Credentials:PHARMACY TCHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 11877
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9739
Mailing Address - Country:US
Mailing Address - Phone:787-262-6131
Mailing Address - Fax:
Practice Address - Street 1:BARRIO YEGUADA SECTOR PALMARITO CALLE UNION
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-262-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1938183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician