Provider Demographics
NPI:1104046499
Name:DIAZ, GLORIA ESTHER (920)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ESTHER
Last Name:DIAZ
Suffix:
Gender:F
Credentials:920
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 988
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-857-5836
Mailing Address - Fax:787-857-5836
Practice Address - Street 1:CALLE BARCELO # 8
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-0988
Practice Address - Country:US
Practice Address - Phone:787-857-5836
Practice Address - Fax:787-857-5836
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR920247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist