Healthcare Provider Details

I. General information

NPI: 1235183989
Provider Name (Legal Business Name): WANDA DIAZ BS, RPH, LND, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 B2 CLEMSON UNIVERSITY GARDENS
SAN JUAN PR
00927-4022
US

IV. Provider business mailing address

306 B2 CLEMSON UNIVERSITY GARDENS
SAN JUAN PR
00927-4022
US

V. Phone/Fax

Practice location:
  • Phone: 787-466-7186
  • Fax: 787-751-3482
Mailing address:
  • Phone: 787-466-7186
  • Fax: 787-751-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1212
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4314
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: