Healthcare Provider Details

I. General information

NPI: 1538267620
Provider Name (Legal Business Name): ANA DEL C DIAZ TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB JARDINES DE YABUCOA CALLE 1 A8
YABUCOA PR
00767
US

IV. Provider business mailing address

PO BOX 1168
YABUCOA PR
00767-1168
US

V. Phone/Fax

Practice location:
  • Phone: 787-893-6709
  • Fax: 787-266-6505
Mailing address:
  • Phone: 787-893-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4602
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: