Provider Demographics
NPI:1306687538
Name:ALVARADO SANTANA, EDZAIDA RAQUEL
Entity type:Individual
Prefix:
First Name:EDZAIDA
Middle Name:RAQUEL
Last Name:ALVARADO 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:HC 3 BOX 10665
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9505
Mailing Address - Country:US
Mailing Address - Phone:787-246-5688
Mailing Address - Fax:
Practice Address - Street 1:333 CARR 14
Practice Address - Street 2:WALMART SUPERCENTER 5793
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-651-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR801156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician