Provider Demographics
NPI:1497334486
Name:DIAZ PEREZ, NINOSHKA (DC)
Entity Type:Individual
Prefix:
First Name:NINOSHKA
Middle Name:
Last Name:DIAZ PEREZ
Suffix:
Gender:F
Credentials:DC
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 841
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0841
Mailing Address - Country:US
Mailing Address - Phone:787-376-4459
Mailing Address - Fax:
Practice Address - Street 1:CALLE EL BUEN SAMARITANO
Practice Address - Street 2:D-14
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-792-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor