Provider Demographics
NPI:1427185735
Name:DIAZ, GISELA (PHD)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CALLE CESAR GONZALEZ
Mailing Address - Street 2:COND.PAVILION COURT APT 91
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1401
Mailing Address - Country:US
Mailing Address - Phone:787-764-5744
Mailing Address - Fax:787-721-5349
Practice Address - Street 1:161 CALLE CESAR GONZALEZ
Practice Address - Street 2:COND.PAVILION COURT APT 91
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1401
Practice Address - Country:US
Practice Address - Phone:787-764-5744
Practice Address - Fax:787-721-5349
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3223OtherPHARMACIST