Provider Demographics
NPI:1629518089
Name:BELMONT, DYLEEN
Entity Type:Individual
Prefix:
First Name:DYLEEN
Middle Name:
Last Name:BELMONT
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:N23 CALLE MUNDO NUEVO
Mailing Address - Street 2:URB EL CAFETAL II
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-486-4689
Mailing Address - Fax:
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA
Practice Address - Street 2:SUITE 107 OFIC 1-A
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-8700
Practice Address - Fax:787-659-7006
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5139183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5139OtherPHARMACY TECH STATE LICENCE