Provider Demographics
NPI:1760569800
Name:DIAZ, LUZ V
Entity Type:Individual
Prefix:MISS
First Name:LUZ
Middle Name:V
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 1:1789 CALLE COMPOSTELA
Mailing Address - Street 2:COLLEGE PARK
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4338
Mailing Address - Country:US
Mailing Address - Phone:787-453-2130
Mailing Address - Fax:
Practice Address - Street 1:851 CALLE LAFAYETTE
Practice Address - Street 2:PDA 20
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2627
Practice Address - Country:US
Practice Address - Phone:787-722-5018
Practice Address - Fax:787-721-3399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#3753183700000X
PRCFO02470390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program