Provider Demographics
NPI:1609066877
Name:SUBILLAGA, MARLENE LIZBETH
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:LIZBETH
Last Name:SUBILLAGA
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 436 MY 18 COUNTRY CLUB
Mailing Address - Street 2:CUARTA EXTENCION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:939-969-0712
Mailing Address - Fax:
Practice Address - Street 1:COND. GOLDEN TOWER C8
Practice Address - Street 2:AVE. PONTEZUELA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-769-5240
Practice Address - Fax:787-757-0021
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4845183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician