Provider Demographics
NPI:1730941386
Name:DELGADO ALICEA, IVANIS M
Entity type:Individual
Prefix:
First Name:IVANIS
Middle Name:M
Last Name:DELGADO ALICEA
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:PO BOX 2500
Mailing Address - Street 2:PMB 378
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951
Mailing Address - Country:US
Mailing Address - Phone:939-383-0403
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:939-383-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013209183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician