Provider Demographics
NPI:1922303221
Name:DIAZ RAMIREZ, ROSA A
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:DIAZ RAMIREZ
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:URB. SAN ANTONIO 1768 CALLE DONCELLA
Mailing Address - Street 2:APT #201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1625
Mailing Address - Country:US
Mailing Address - Phone:787-225-4699
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7292183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician