Provider Demographics
NPI:1841562832
Name:DIAZ, JANEZALIZ C (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:JANEZALIZ
Middle Name:C
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PORTAL DE LA REINA
Mailing Address - Street 2:APT 308
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5755
Mailing Address - Country:US
Mailing Address - Phone:787-647-5096
Mailing Address - Fax:
Practice Address - Street 1:PORTAL DE LA REINA
Practice Address - Street 2:APT 308
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5755
Practice Address - Country:US
Practice Address - Phone:787-647-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR767156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician