=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144318783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESUS M. DIAZ DELGADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 113 KM 13.6
-----------------------------------------------------
City | QUEBRADILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-895-6707
-----------------------------------------------------
Fax | 787-895-6675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1369
-----------------------------------------------------
City | HATILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00659-1369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-895-6707
-----------------------------------------------------
Fax | 787-895-6675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PIC
-----------------------------------------------------
Name | MAYRA TOLEDO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 787-895-6707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | BF9444958
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------