Provider Demographics
NPI:1831303296
Name:CRESPO, MARITZA I (LCDA)
Entity Type:Individual
Prefix:PROF
First Name:MARITZA
Middle Name:I
Last Name:CRESPO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TERRAZAS DE CARRAIZO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9189
Mailing Address - Country:US
Mailing Address - Phone:787-748-5937
Mailing Address - Fax:787-274-8477
Practice Address - Street 1:#1 PARANA ST.
Practice Address - Street 2:CENTRO COMERCIAL RIO PIEDRAS HGTS.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-764-2899
Practice Address - Fax:787-274-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3168Medicare UPIN