Provider Demographics
NPI:1285847244
Name:CHICLANA, IVETTE (MD)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:CHICLANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SS 8 PLAZA 9
Mailing Address - Street 2:URB. MANSION DEL SUR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4819
Mailing Address - Country:US
Mailing Address - Phone:787-795-2485
Mailing Address - Fax:
Practice Address - Street 1:SS 8 PLAZA 9
Practice Address - Street 2:URB. MANSION DEL SUR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4819
Practice Address - Country:US
Practice Address - Phone:787-795-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5560OtherSTATE MEDICAL LICENCE