Provider Demographics
NPI:1255472361
Name:CARDE, OMAYRA RODRIGUEZ (LICD)
Entity Type:Individual
Prefix:MRS
First Name:OMAYRA
Middle Name:RODRIGUEZ
Last Name:CARDE
Suffix:
Gender:F
Credentials:LICD
Other - Prefix:MRS
Other - First Name:OMAYRA
Other - Middle Name:RODRIGUEZ
Other - Last Name:CARDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICD
Mailing Address - Street 1:MIGRANT HEALTH CENTER, INC.
Mailing Address - Street 2:P O BOX 7128
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7128
Mailing Address - Country:US
Mailing Address - Phone:787-805-2900
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:MIGRANT HEALTH CENTER, INC.
Practice Address - Street 2:BO PIEDRAS BLANCAS CARR 119 KM 35.2
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1665
Practice Address - Fax:787-896-1690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR078213OtherREGISTRO