Provider Demographics
NPI:1578820304
Name:DIAZ-ORTIZ, JEANNETTE XIOMARA
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:XIOMARA
Last Name:DIAZ-ORTIZ
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:PO BOX 365028
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5028
Mailing Address - Country:US
Mailing Address - Phone:787-754-2525
Mailing Address - Fax:787-767-3968
Practice Address - Street 1:CENTRO MEDICO DE PR, HOSPITAL INDUSTRIAL
Practice Address - Street 2:FONDO SEGURO DEL ESTADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5028
Practice Address - Country:US
Practice Address - Phone:787-754-2525
Practice Address - Fax:787-767-3968
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist