Provider Demographics
NPI:1821450636
Name:BENITEZ-PAGAN, NOMARIS (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:NOMARIS
Middle Name:
Last Name:BENITEZ-PAGAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CALLE SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR - PUERTO RICO
Mailing Address - Zip Code:00961-7031
Mailing Address - Country:UM
Mailing Address - Phone:787-462-6102
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTA CRUZ #68
Practice Address - Street 2:TORRE SAN PABLO SUITE #2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0096
Practice Address - Country:US
Practice Address - Phone:787-620-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9940183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6121236OtherLICENCIA DE CONDUCIR