Provider Demographics
NPI:1851413694
Name:SIERRA, VILIAN J
Entity Type:Individual
Prefix:
First Name:VILIAN
Middle Name:J
Last Name:SIERRA
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 1:4 CALLE 3A
Mailing Address - Street 2:PUEBLO NUEVO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4910
Mailing Address - Country:US
Mailing Address - Phone:787-807-1712
Mailing Address - Fax:787-858-1336
Practice Address - Street 1:C2 CALLE2
Practice Address - Street 2:VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-1336
Practice Address - Fax:787-858-1336
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003175183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician