Provider Demographics
NPI:1235183989
Name:DIAZ, WANDA (BS, RPH, LND, CDE)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BS, RPH, LND, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 B2 CLEMSON
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4022
Mailing Address - Country:US
Mailing Address - Phone:787-466-7186
Mailing Address - Fax:787-751-3482
Practice Address - Street 1:306 B2 CLEMSON
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4022
Practice Address - Country:US
Practice Address - Phone:787-466-7186
Practice Address - Fax:787-751-3482
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1212133NN1002X
PR4314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered183500000XPharmacy Service ProvidersPharmacist