Healthcare Provider Details

I. General information

NPI: 1376851139
Provider Name (Legal Business Name): EVELYN DIAZ-PEREZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CALLE PERIDOT LOS PRADOS SUR
DORADO PR
00646-9658
US

IV. Provider business mailing address

113 CALLE PERIDOT
DORADO PR
00646-9658
US

V. Phone/Fax

Practice location:
  • Phone: 787-598-8247
  • Fax:
Mailing address:
  • Phone: 787-598-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3222
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: