Provider Demographics
NPI:1245523042
Name:SANTANA, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:SANTANA
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:AVE.LAUREL & ALAMEDA
Mailing Address - Street 2:G-1 SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00956
Mailing Address - Country:UM
Mailing Address - Phone:787-269-4200
Mailing Address - Fax:787-269-4270
Practice Address - Street 1:COND LAUREL # Y
Practice Address - Street 2:G-1 SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3273
Practice Address - Country:US
Practice Address - Phone:787-269-4200
Practice Address - Fax:787-269-4270
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist