Provider Demographics
NPI:1033481874
Name:DIAZ, IRMA (BSPH)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0780
Mailing Address - Country:US
Mailing Address - Phone:787-882-2700
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO. 2 KM. 26.2
Practice Address - Street 2:BO. ESPINOSA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00664-0000
Practice Address - Country:US
Practice Address - Phone:787-882-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4909OtherSTATE LICENSE