Provider Demographics
NPI:1972834547
Name:ALVARADO-DIAZ, ILIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:ILIANA
Middle Name:
Last Name:ALVARADO-DIAZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CALLE CRUZ ORTIZ STELLA STE 11
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4144
Mailing Address - Country:US
Mailing Address - Phone:787-367-6238
Mailing Address - Fax:877-496-5503
Practice Address - Street 1:250 CALLE CRUZ ORTIZ STELLA STE 11
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4144
Practice Address - Country:US
Practice Address - Phone:939-428-1140
Practice Address - Fax:877-496-5503
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist