Provider Demographics
NPI:1295141737
Name:CANCEL-FERNANDEZ, JAMIL
Entity type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:CANCEL-FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMIL
Other - Middle Name:
Other - Last Name:CANCEL-FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSB,CPTH
Mailing Address - Street 1:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1255
Mailing Address - Country:US
Mailing Address - Phone:787-246-1684
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE FRANCISCO ALVAREZ
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5269
Practice Address - Country:US
Practice Address - Phone:787-246-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6813183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR131735Other6813