Provider Demographics
NPI:1750686333
Name:MOJICA, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MOJICA
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:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:787-641-0794
Practice Address - Street 1:APS HEALTHCARE PUERTO RICO NO. 2 CHARDON AVENUE
Practice Address - Street 2:SUITE 200A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8574
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:787-641-0794
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5483183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician