Provider Demographics
NPI:1780719864
Name:ILLAS, DAMARIS (TECH)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:ILLAS
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CALLE STA. ELENA 1697
Mailing Address - Street 2:URB. ALTAMESA
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-765-6768
Mailing Address - Fax:787-765-5937
Practice Address - Street 1:455 AVE PONCE DE LEON
Practice Address - Street 2:ESQ. RUIZ BELVIS FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3711
Practice Address - Country:US
Practice Address - Phone:787-765-6768
Practice Address - Fax:787-765-5937
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2123183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician