Provider Demographics
NPI:1902149560
Name:OLIVERAS MONTIJO, NAYDA
Entity Type:Individual
Prefix:
First Name:NAYDA
Middle Name:
Last Name:OLIVERAS MONTIJO
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:P.O. BOX 1978
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:P. R.
Mailing Address - Zip Code:00638
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CARR 149
Practice Address - Street 2:SUITE 1
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9662
Practice Address - Country:US
Practice Address - Phone:787-871-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5648183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician