Provider Demographics
NPI:1114046992
Name:DIAZ, SHEILA PEREA
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:PEREA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CALLE 7
Mailing Address - Street 2:URB. BRISAS DE CEIBA
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3117
Mailing Address - Country:US
Mailing Address - Phone:787-608-9027
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA SAN MIGUEL
Practice Address - Street 2:CALLE DR. LOPEZ # 54
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004277OtherAUXILIAR DE FARMACIA