Provider Demographics
NPI:1538497730
Name:ORTIZ GONZALEZ, KATHIANE (PHARMACY TECHNITIAN)
Entity Type:Individual
Prefix:
First Name:KATHIANE
Middle Name:
Last Name:ORTIZ GONZALEZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AI9 CALLE 1
Mailing Address - Street 2:URB.VILLA DEL CARMEN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2101
Mailing Address - Country:US
Mailing Address - Phone:787-469-4606
Mailing Address - Fax:
Practice Address - Street 1:AI9 CALLE 1
Practice Address - Street 2:URB.VILLA DEL CARMEN
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2101
Practice Address - Country:US
Practice Address - Phone:787-469-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6912183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician