Provider Demographics
NPI:1306064191
Name:SANTA ANA HOLDINGS GROUP INC
Entity type:Organization
Organization Name:SANTA ANA HOLDINGS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEBLES SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-842-2285
Mailing Address - Street 1:367 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3473
Mailing Address - Country:US
Mailing Address - Phone:787-842-2285
Mailing Address - Fax:787-844-0983
Practice Address - Street 1:367 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3473
Practice Address - Country:US
Practice Address - Phone:787-842-2285
Practice Address - Fax:787-844-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F15833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2083469OtherPK