Provider Demographics
NPI:1518093517
Name:DIAZ, MARIBELLE
Entity Type:Individual
Prefix:
First Name:MARIBELLE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN MARTIN
Mailing Address - Street 2:C-20
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-0000
Mailing Address - Country:US
Mailing Address - Phone:787-771-7919
Mailing Address - Fax:787-771-7442
Practice Address - Street 1:URB. SAN MARTIN
Practice Address - Street 2:C-20
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-0000
Practice Address - Country:US
Practice Address - Phone:787-771-7919
Practice Address - Fax:787-771-7442
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4603183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician