Provider Demographics
NPI:1427199660
Name:DIAZ, LAURA I (BSPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DE SAN FERNANDO,4 STREET A-27
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5208
Mailing Address - Country:US
Mailing Address - Phone:787-257-8757
Mailing Address - Fax:787-769-6688
Practice Address - Street 1:FARMACIA LUIS DE P.R.,CENTRO COMERCIAL LAGUNA GARDENS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-791-2171
Practice Address - Fax:787-253-1002
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist