Provider Demographics
NPI:1801298021
Name:DEL REAL PUJOL, ORIETTA
Entity type:Individual
Prefix:
First Name:ORIETTA
Middle Name:
Last Name:DEL REAL PUJOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 NW 124TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2465
Mailing Address - Country:US
Mailing Address - Phone:786-439-9796
Mailing Address - Fax:
Practice Address - Street 1:18280 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1813
Practice Address - Country:US
Practice Address - Phone:305-256-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist