Provider Demographics
NPI:1235264706
Name:DIAZ, MARIBEL (RPH)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:DIAZ
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:PO BOX 2510
Mailing Address - Street 2:PMB 227
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2510
Mailing Address - Country:US
Mailing Address - Phone:787-755-1221
Mailing Address - Fax:787-755-1288
Practice Address - Street 1:852 STREET DOS BOCAS
Practice Address - Street 2:0.1 HECTOMETER
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977
Practice Address - Country:US
Practice Address - Phone:787-755-1200
Practice Address - Fax:787-755-1288
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist