Provider Demographics
NPI:1497973283
Name:HERNANDEZ, CARMEN KATIVIA (RPT)
Entity Type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:KATIVIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:HERNANDEZ
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:367 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3473
Mailing Address - Country:US
Mailing Address - Phone:787-842-2285
Mailing Address - Fax:787-844-0983
Practice Address - Street 1:367 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3473
Practice Address - Country:US
Practice Address - Phone:787-842-2285
Practice Address - Fax:787-844-0983
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5764183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician