Provider Demographics
NPI:1558406421
Name:CHINEA, ELBA IRIS
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:IRIS
Last Name:CHINEA
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:RR 5 BOX 5333
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-797-5555
Mailing Address - Fax:787-797-5555
Practice Address - Street 1:CARR 167 KM 11.0
Practice Address - Street 2:BO. DAJAOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9711
Practice Address - Country:US
Practice Address - Phone:787-797-5555
Practice Address - Fax:787-797-5555
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNABPOther400208