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General NPI Number Information
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NPI Number | 1639787161
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Entity Type | Individual
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Provider Name | MISS JESSICA DIAZ GARCIA III
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | B2 CARR 14
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City | CAYEY
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State | PR
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Zip | 00736-5060
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Country | US
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Telephone | 787-225-5196
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Fax |
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Provider Business Mailing Address
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Address Line | HC 45 BOX 13703
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City | CAYEY
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State | PR
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Zip | 00736-9723
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Country | US
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Telephone | 787-225-5196
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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 | 013221
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License Number State | PR
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