Provider Demographics
NPI:1780818492
Name:DIAZ, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
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:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-8908
Mailing Address - Country:US
Mailing Address - Phone:787-536-8119
Mailing Address - Fax:
Practice Address - Street 1:132 CALLE UMBRAL
Practice Address - Street 2:URB VILLA TOLEDO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9689
Practice Address - Country:US
Practice Address - Phone:787-817-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8058183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician