Provider Demographics
NPI:1396942553
Name:INFANTE, JANET IVELISSE (4172347)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:IVELISSE
Last Name:INFANTE
Suffix:
Gender:F
Credentials:4172347
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CALLE CORDOVA
Mailing Address - Street 2:URB. PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5122
Mailing Address - Country:US
Mailing Address - Phone:787-235-9975
Mailing Address - Fax:
Practice Address - Street 1:1000 AVE JESUS T PINERO
Practice Address - Street 2:URB. PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1819
Practice Address - Country:US
Practice Address - Phone:787-782-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician