Provider Demographics
NPI:1699810564
Name:MORALES-PEREZ, MYRTELINA (PT)
Entity Type:Individual
Prefix:
First Name:MYRTELINA
Middle Name:
Last Name:MORALES-PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-0765
Mailing Address - Country:US
Mailing Address - Phone:787-847-1412
Mailing Address - Fax:787-847-6678
Practice Address - Street 1:41 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2218
Practice Address - Country:US
Practice Address - Phone:787-847-1412
Practice Address - Fax:787-847-6678
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1094183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician