Provider Demographics
NPI:1083781082
Name:DIAZ ROSADO, MAGALI (RPH)
Entity Type:Individual
Prefix:
First Name:MAGALI
Middle Name:
Last Name:DIAZ ROSADO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 222 2 CALLE 601
Mailing Address - Street 2:URB VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-2203
Mailing Address - Country:US
Mailing Address - Phone:787-276-5672
Mailing Address - Fax:787-772-4524
Practice Address - Street 1:224 DOMENECH AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3515
Practice Address - Country:US
Practice Address - Phone:787-753-0794
Practice Address - Fax:787-772-4524
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist