Provider Demographics
NPI:1487727665
Name:AYENDE, KIVIAN M
Entity type:Individual
Prefix:MISS
First Name:KIVIAN
Middle Name:M
Last Name:AYENDE
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 1 BOX 4780
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-9704
Mailing Address - Country:US
Mailing Address - Phone:787-846-4583
Mailing Address - Fax:787-846-2334
Practice Address - Street 1:HC 1 BOX 4780
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-9704
Practice Address - Country:US
Practice Address - Phone:787-846-4583
Practice Address - Fax:787-846-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5370183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician