Basic Information
| Provider Information | |||||||||
| NPI: | 1518093517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | MARIBELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB SAN MARTIN | ||||||||
| Address2: | C-20 | ||||||||
| City: | UTUADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006410000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877717919 | ||||||||
| FaxNumber: | 7877717442 | ||||||||
| Practice Location | |||||||||
| Address1: | URB. SAN MARTIN | ||||||||
| Address2: | C-20 | ||||||||
| City: | UTUADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006410000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877717919 | ||||||||
| FaxNumber: | 7877717442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 183700000X | 4603 | PR | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.