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General NPI Number Information
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NPI Number | 1285272898
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Entity Type | Individual
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Provider Name | CHAIMARIE DIAZ GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | SANTA MARIA MEDICAL BUILDING SUITE 102 AVE. FERROCARRIL
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City | PONCE
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State | PR
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Zip | 00718
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Country | US
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Telephone | 787-403-8711
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 5395
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City | PENUELAS
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State | PR
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Zip | 00624-9692
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Country | US
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Telephone | 787-403-8711
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | PR
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