Provider Demographics
NPI:1851620652
Name:DIAZ, MARIA ELENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B#11
Mailing Address - Street 2:LAS VILLAS TOENHOUSES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-640-7362
Mailing Address - Fax:787-731-1614
Practice Address - Street 1:11 CALLE B
Practice Address - Street 2:LAS VILLAS TOWNHOUSES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-5227
Practice Address - Country:US
Practice Address - Phone:787-640-7362
Practice Address - Fax:787-731-1614
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist