Provider Demographics
NPI:1962235101
Name:GONZALEZ SERRANO, DAYANARA
Entity type:Individual
Prefix:
First Name:DAYANARA
Middle Name:
Last Name:GONZALEZ SERRANO
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 1:443 CARR 3
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4654
Mailing Address - Country:US
Mailing Address - Phone:787-852-2828
Mailing Address - Fax:
Practice Address - Street 1:443 CARR 3
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4654
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7296183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician