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General NPI Number Information
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NPI Number | 1609915859
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Entity Type | Individual
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Provider Name | MRS. WANDA I DIAZ
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE 1 B 6 VILLAS DEL MADRIGAL
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-769-8224
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 1 B 6 VILLAS DEL MADRIGAL
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City | CAROLINA
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State | PR
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Zip | 00987-0000
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Country | US
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Telephone | 787-769-8224
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 005010
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License Number State | PR
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