Provider Demographics
NPI:1578771051
Name:HIRALDO, RAUL
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:HIRALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CUBA #416
Mailing Address - Street 2:URB.FLORAL PARK
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-587-8606
Mailing Address - Fax:787-756-8807
Practice Address - Street 1:CALLE CUBA # 416
Practice Address - Street 2:URB.FLORAL PARK
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-587-8606
Practice Address - Fax:787-756-8807
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4468183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician