Provider Demographics
NPI:1477792083
Name:DIAZ, MARIA DEL C (LND)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL C
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LND
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 1379
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1379
Mailing Address - Country:US
Mailing Address - Phone:787-735-8001
Mailing Address - Fax:787-735-7172
Practice Address - Street 1:CALLE DR. TROYER
Practice Address - Street 2:#3
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-735-8001
Practice Address - Fax:787-735-7172
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1181133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR19023ASOtherALFA NUMERIC SETTINGS AS A MEMBER OF A GROUP WHO PROVIDE SERVICES UNDER MEDICARE
PRP61382Medicare UPIN