Provider Demographics
NPI:1265649214
Name:ALICEA, RUTH D
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:ALICEA
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 1:21 CALLE E # 308
Mailing Address - Street 2:BO.CELADA CARRETERA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2025
Mailing Address - Country:US
Mailing Address - Phone:787-470-4035
Mailing Address - Fax:
Practice Address - Street 1:8 CARR 31
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3871
Practice Address - Country:US
Practice Address - Phone:787-734-7622
Practice Address - Fax:787-713-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician