Provider Demographics
NPI:1801465422
Name:DELGADO DIAZ, JETZABEL (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JETZABEL
Middle Name:
Last Name:DELGADO DIAZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 33 BOX 5248
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LOS PRADOS SHOPPING CENTER LOCAL B-10 YB-11 GRAND
Practice Address - Street 2:BOULEVARD LOS PRADOS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-744-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8191390200000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program