Healthcare Provider Details

I. General information

NPI: 1982253993
Provider Name (Legal Business Name): MARIBEL RODRIGUEZ DIAZ OPTICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BDA CAMPAMENTO 13 CALLE 6
GURABO PR
00778-2024
US

IV. Provider business mailing address

BDA CAMPAMENTO 13 CALLE 6
GURABO PR
00778-2024
US

V. Phone/Fax

Practice location:
  • Phone: 787-363-1752
  • Fax: 787-737-6373
Mailing address:
  • Phone: 787-363-1752
  • Fax: 787-737-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1337
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: