Provider Demographics
NPI:1033401229
Name:DIAZ, LORRAINE (LND)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE DOLORES CABRERA ALONSO 13
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-2470
Mailing Address - Fax:787-285-4165
Practice Address - Street 1:13 CALLE DOLORES CABRERA ALONSO W
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4095
Practice Address - Country:US
Practice Address - Phone:787-852-2470
Practice Address - Fax:787-285-4165
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1598133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist