Provider Demographics
NPI:1972207660
Name:GOMEZ-NEGRON, MARIA ANGELICA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:GOMEZ-NEGRON
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 5 BOX 6496
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9074
Mailing Address - Country:US
Mailing Address - Phone:787-478-3227
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 164 SECTOR EL DESVIO
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist