Provider Demographics
NPI:1790210995
Name:BERRIOS, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BERRIOS
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:CALLE 156 KM 0.1 INT
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0781
Mailing Address - Country:US
Mailing Address - Phone:787-867-1430
Mailing Address - Fax:787-867-4848
Practice Address - Street 1:CALLE 156 KM 0.1
Practice Address - Street 2:PUEBLO
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-1430
Practice Address - Fax:787-867-4848
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7298183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician