Provider Demographics
NPI:1275541260
Name:ESCUDERO, DIMARYS (PT)
Entity Type:Individual
Prefix:
First Name:DIMARYS
Middle Name:
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE LOS MILAGROS
Mailing Address - Street 2:#9
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638
Mailing Address - Country:US
Mailing Address - Phone:787-599-1114
Mailing Address - Fax:
Practice Address - Street 1:CARR. 160 KM 4.5
Practice Address - Street 2:BO ALMIRANTE NORTE
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-917-0603
Practice Address - Fax:787-917-0688
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5587183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician