Provider Demographics
NPI:1114693256
Name:ALEJANDRO, DITZA (ND)
Entity Type:Individual
Prefix:
First Name:DITZA
Middle Name:
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CALLE RHIN
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9414
Mailing Address - Country:US
Mailing Address - Phone:939-253-6375
Mailing Address - Fax:
Practice Address - Street 1:467 AVE SAGRADO CORAZON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3300
Practice Address - Country:US
Practice Address - Phone:787-363-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000075202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner