Provider Demographics
NPI:1225240989
Name:DELIZ, AXEL
Entity Type:Individual
Prefix:
First Name:AXEL
Middle Name:
Last Name:DELIZ
Suffix:
Gender:M
Credentials:
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 196
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0196
Mailing Address - Country:US
Mailing Address - Phone:787-895-1297
Mailing Address - Fax:787-872-2145
Practice Address - Street 1:1- 350 G NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1127
Practice Address - Country:US
Practice Address - Phone:787-872-1930
Practice Address - Fax:787-872-2145
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5585183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician