Provider Demographics
NPI:1376677039
Name:ALICEA, MARIA J
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
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 1:206 CALLE TOCANTIS
Mailing Address - Street 2:RIO PIEDRAS HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3219
Mailing Address - Country:US
Mailing Address - Phone:787-758-6901
Mailing Address - Fax:
Practice Address - Street 1:1228 CALLE 9 ESQ52
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-4235
Practice Address - Country:US
Practice Address - Phone:787-758-8497
Practice Address - Fax:787-759-8192
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist