Provider Demographics
NPI:1720296247
Name:DIAZ-OTERO, MARIA DE LOURDES (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA DE LOURDES
Middle Name:
Last Name:DIAZ-OTERO
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:AVE SANTA ANA #262
Mailing Address - Street 2:CENTRO COMERCIAL SANTA ANA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-272-1205
Mailing Address - Fax:787-720-9379
Practice Address - Street 1:AVE SANTA ANA #262
Practice Address - Street 2:CENTRO COMERCIAL SANTA ANA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-1205
Practice Address - Fax:787-720-9379
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2634OtherPR PHARMACIST LICENSE