=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285403204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. DAVID LOPEZ DIAZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2024
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 AVE. LASIERRA #177
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-292-2050
-----------------------------------------------------
Fax | 787-755-6836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 AVE. LASIERRA #177
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-292-2050
-----------------------------------------------------
Fax | 787-755-6836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 015788
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------