Provider Demographics
NPI:1417162827
Name:FARMACIA CULEBRA IPA 508
Entity Type:Organization
Organization Name:FARMACIA CULEBRA IPA 508
Other - Org Name:JUNTA DEL CENTRO DE COMUNAL DR. JOSE S. BELAVAL INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-268-3711
Mailing Address - Street 1:PO BOX 14457
Mailing Address - Street 2:BO OBRERO STATION
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00916
Mailing Address - Country:US
Mailing Address - Phone:787-268-3711
Mailing Address - Fax:
Practice Address - Street 1:CALLE WILLIAM FONT
Practice Address - Street 2:
Practice Address - City:CULEBRA
Practice Address - State:PR
Practice Address - Zip Code:00775
Practice Address - Country:US
Practice Address - Phone:787-742-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR453607333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy