Basic Information
| Provider Information | |||||||||
| NPI: | 1477792083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DEL C | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LND | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1379 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
| FaxNumber: | 7877357172 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE DR. TROYER | ||||||||
| Address2: | #3 | ||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877358001 | ||||||||
| FaxNumber: | 7877357172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 02/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 1181 | PR | Y | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
ID Information
| ID | Type | State | Issuer | Description | 19023AS | 01 | PR | ALFA NUMERIC SETTINGS AS A MEMBER OF A GROUP WHO PROVIDE SERVICES UNDER MEDICARE | OTHER |