Provider Demographics
NPI:1639594989
Name:ORTIZ DIAZ, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ORTIZ 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 1:3032 CALLE ESMERALDA
Mailing Address - Street 2:URBANIZACION LAGO HORIZONTE
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2420
Mailing Address - Country:US
Mailing Address - Phone:787-451-5948
Mailing Address - Fax:787-847-6678
Practice Address - Street 1:41 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3036
Practice Address - Country:US
Practice Address - Phone:787-847-1412
Practice Address - Fax:787-847-6678
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7144183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7144OtherPHARMACY TECHNICIAN