Provider Demographics
NPI:1821098831
Name:DIAZ, GLORIA ESTHER CASTILLO
Entity Type:Individual
Prefix:MRS
First Name:GLORIA ESTHER
Middle Name:CASTILLO
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:BB4 CALLE 32
Mailing Address - Street 2:URB. CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2103
Mailing Address - Country:US
Mailing Address - Phone:787-364-1784
Mailing Address - Fax:
Practice Address - Street 1:19 CALLE ACUARIO
Practice Address - Street 2:SUITE 16
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4902
Practice Address - Country:US
Practice Address - Phone:787-761-4990
Practice Address - Fax:787-748-1935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist