Provider Demographics
NPI:1295876381
Name:CARRION, GRISSEL I ACABA (LCDA)
Entity type:Individual
Prefix:MRS
First Name:GRISSEL I
Middle Name:ACABA
Last Name:CARRION
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:MRS
Other - First Name:GRISSEL I
Other - Middle Name:ACABA
Other - Last Name:CARRION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDA
Mailing Address - Street 1:MIGRANT HEALTH CENTER, INC
Mailing Address - Street 2:P O BOX 7128
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7128
Mailing Address - Country:US
Mailing Address - Phone:787-805-2900
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:MIGRANT HEALTH CENTER, INC.
Practice Address - Street 2:BO PIEDRAS BLANCAS CARR 119 KM 35.2
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1665
Practice Address - Fax:787-896-1690
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051357OtherNUMERO DE REGISTRO