Provider Demographics
NPI:1154549848
Name:BURGOS, MARIA SOCORRO
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SOCORRO
Last Name:BURGOS
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:CS14 CALLE 122
Mailing Address - Street 2:VALLE ARRIBA HEIGTHS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3342
Mailing Address - Country:US
Mailing Address - Phone:787-240-9195
Mailing Address - Fax:
Practice Address - Street 1:CS14 CALLE 122
Practice Address - Street 2:VALLE ARRIBA HEIGTHS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3342
Practice Address - Country:US
Practice Address - Phone:787-240-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist