Provider Demographics
NPI:1265598924
Name:RIOLLANO CHICO, AWILDA (LCDA)
Entity type:Individual
Prefix:
First Name:AWILDA
Middle Name:
Last Name:RIOLLANO CHICO
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0957
Mailing Address - Country:US
Mailing Address - Phone:787-895-3060
Mailing Address - Fax:787-895-1804
Practice Address - Street 1:157 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0957
Practice Address - Country:US
Practice Address - Phone:787-895-3060
Practice Address - Fax:787-895-1804
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1264210001Medicare ID - Type Unspecified