Provider Demographics
NPI:1821701228
Name:LLANTIN PUMAREJO, ANA MEDDIE (CSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MEDDIE
Last Name:LLANTIN PUMAREJO
Suffix:
Gender:F
Credentials:CSW
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 1794
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1794
Mailing Address - Country:US
Mailing Address - Phone:787-384-8452
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE FRANCISCO ORTIZ LEBRON
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-2813
Practice Address - Country:US
Practice Address - Phone:787-384-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR123456789OtherNOT YET ID