Healthcare Provider Details

I. General information

NPI: 1841332079
Provider Name (Legal Business Name): DIANNA YAACOUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 AVE. LUIS MUNOZ MARIN SUITE 105
CAGUAS PR
00725-4013
US

IV. Provider business mailing address

HACIENDA SAN JOSE 617 VIA DEL GUAYABAL
CAGUAS PR
00727-3070
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-6849
  • Fax: 787-743-6849
Mailing address:
  • Phone: 787-934-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4124
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: