Provider Demographics
NPI:1265574982
Name:DIAZ, LYZZETTE AURORA (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:LYZZETTE
Middle Name:AURORA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0564
Mailing Address - Country:US
Mailing Address - Phone:787-874-2523
Mailing Address - Fax:787-893-3984
Practice Address - Street 1:CALLE CRISTOBAL COLON NUM.52
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-874-2523
Practice Address - Fax:787-893-3984
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2895OtherPHARMACIST