Provider Demographics
NPI:1730537960
Name:VELILLA, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:VELILLA
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:J12 CALLE SAN PEDRO
Mailing Address - Street 2:ESTANCIAS DE SAN PEDRO
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-362-2976
Mailing Address - Fax:
Practice Address - Street 1:J-12 CALLE SAN PEDRO
Practice Address - Street 2:ESTANCIAS DE SAN PEDRO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-362-2976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4436183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician