Provider Demographics
NPI:1134344765
Name:EUSEBIO, ANGELITA
Entity type:Individual
Prefix:MRS
First Name:ANGELITA
Middle Name:
Last Name:EUSEBIO
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:PO BOX 193722
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3722
Mailing Address - Country:US
Mailing Address - Phone:787-763-5308
Mailing Address - Fax:787-763-5312
Practice Address - Street 1:388 CALLE AMERICA
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4214
Practice Address - Country:US
Practice Address - Phone:787-763-5308
Practice Address - Fax:787-763-5312
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005389183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005389OtherTECHNICIAN LICENSE
PR118398OtherTECHNICIAN REGISTER