Provider Demographics
NPI:1891061743
Name:MONCLOVA, ISTAR IVETTE (1928)
Entity Type:Individual
Prefix:MRS
First Name:ISTAR
Middle Name:IVETTE
Last Name:MONCLOVA
Suffix:
Gender:F
Credentials:1928
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AQ8 RIO TONADOR
Mailing Address - Street 2:VALLE VERDE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-620-9601
Mailing Address - Fax:
Practice Address - Street 1:RIO TONADOR A Q NUMERO 8
Practice Address - Street 2:VERDE VALLE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-620-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist