Basic Information
Provider Information
NPI: 1003153388
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: APONTE
FirstName: ENID
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: M16 CALLE TOPACIO
Address2: LA PLATA
City: CAYEY
State: PR
PostalCode: 007364868
CountryCode: US
TelephoneNumber: 7873490491
FaxNumber:  
Practice Location
Address1: M16 CALLE TOPACIO
Address2: LA PLATA
City: CAYEY
State: PR
PostalCode: 007364868
CountryCode: US
TelephoneNumber: 7873490491
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/07/2013
LastUpdateDate: 01/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183700000X8075PRY Pharmacy Service ProvidersPharmacy Technician 

No ID Information.


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