Provider Demographics
NPI:1902090442
Name:QUINTANA-FRATICELLI, BRENDA (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:QUINTANA-FRATICELLI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO SALTILLO SECTOR LOS CONDOMINIOS
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601
Mailing Address - Country:US
Mailing Address - Phone:787-829-5644
Mailing Address - Fax:787-844-0180
Practice Address - Street 1:2188 AVE EDUARDO RUBERTE STE 105
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0601
Practice Address - Country:US
Practice Address - Phone:787-844-1084
Practice Address - Fax:787-844-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6578183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician