Provider Demographics
NPI:1578894457
Name:ADORNO, IVONNE
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:ADORNO
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:CALLE FLAMINGO #165
Mailing Address - Street 2:VILLAS DE LA PLAYA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00693
Mailing Address - Country:UM
Mailing Address - Phone:787-386-9329
Mailing Address - Fax:
Practice Address - Street 1:500 CARR 149 STE 1
Practice Address - Street 2:BO CAMPAMENTO
Practice Address - City:CIALES
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00638
Practice Address - Country:UM
Practice Address - Phone:787-871-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist