Provider Demographics
NPI:1558424358
Name:BRACETTY, DORIAN
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:BRACETTY
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 1:3 CALLE SALAS TORRES
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-3336
Mailing Address - Country:US
Mailing Address - Phone:787-376-0755
Mailing Address - Fax:787-732-2241
Practice Address - Street 1:3 CALLE SALAS TORRES
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3336
Practice Address - Country:US
Practice Address - Phone:787-732-2241
Practice Address - Fax:787-732-2241
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist