Provider Demographics
NPI:1255707238
Name:AVILES, GLENDA LUZ
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:LUZ
Last Name:AVILES
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:CALLE LOIZA #2428
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00913
Mailing Address - Country:UM
Mailing Address - Phone:787-726-0295
Mailing Address - Fax:787-726-8768
Practice Address - Street 1:2428 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913-4731
Practice Address - Country:US
Practice Address - Phone:787-726-0295
Practice Address - Fax:787-726-8798
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10078183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician