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General NPI Number Information
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NPI Number | 1861746836
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Entity Type | Individual
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Provider Name | MARIELY DIAZ RPH
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Gender | Female
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | CARR 2 KM 26.2 ESPINOSA WARD
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-883-5959
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Fax | 787-883-6040
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Provider Business Mailing Address
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Address Line | HC 3 BOX 7525
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City | DORADO
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State | PR
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Zip | 00646-9539
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Country | US
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Telephone | 787-883-5957
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Fax | 787-883-6040
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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 | 5054
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License Number State | PR
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