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General NPI Number Information
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NPI Number | 1245587351
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Entity Type | Individual
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Provider Name | DAMAIRA IVETTE DIAZ ORTIZ RPH
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Gender | Female
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 100 CALLE COLINA REAL LAS COLINAS
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City | TOA BAJA
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State | PR
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Zip | 00951
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Country | US
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Telephone | 787-779-8385
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Fax | 787-779-8392
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Provider Business Mailing Address
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Address Line | PO BOX 1872
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City | OROCOVIS
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State | PR
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Zip | 00720-1872
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Country | US
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Telephone | 787-215-8156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5598
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License Number State | PR
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