Provider Demographics
NPI:1508904202
Name:DIAZ, LUZ I (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 3708
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-9801
Mailing Address - Country:US
Mailing Address - Phone:787-391-5319
Mailing Address - Fax:
Practice Address - Street 1:CALLE BARCELO #17
Practice Address - Street 2:TU FARMACIA FAMILIAR
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-861-4855
Practice Address - Fax:787-861-1056
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4601183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4601OtherLIC PHARMACY TECH