Provider Demographics
NPI:1982253993
Name:RODRIGUEZ DIAZ, MARIBEL (OPTICO)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:F
Credentials:OPTICO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BDA CAMPAMENTO
Mailing Address - Street 2:13 CALLE 6
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2024
Mailing Address - Country:US
Mailing Address - Phone:787-363-1752
Mailing Address - Fax:787-737-6373
Practice Address - Street 1:BDA CAMPAMENTO
Practice Address - Street 2:13 CALLE 6
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2024
Practice Address - Country:US
Practice Address - Phone:787-363-1752
Practice Address - Fax:787-737-6373
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1337156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician