Provider Demographics
NPI:1245439637
Name:DIAZ, MYRNA IRIS (ENFERMERA)
Entity type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:IRIS
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ENFERMERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-01 BOX 4613
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9802
Mailing Address - Country:US
Mailing Address - Phone:787-737-1161
Mailing Address - Fax:
Practice Address - Street 1:AVE RAFAEL CORDERO FINAL #28
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-737-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse