Provider Demographics
NPI:1295041317
Name:MAISONET, VICTOR L
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:L
Last Name:MAISONET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 URB VALLES DE ANASCO
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9601
Mailing Address - Country:US
Mailing Address - Phone:787-882-7900
Mailing Address - Fax:
Practice Address - Street 1:213 URB VALLES DE ANASCO
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9601
Practice Address - Country:US
Practice Address - Phone:787-882-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4196247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4196OtherPHARMACY TECHNICIAN