Provider Demographics
NPI:1124441548
Name:DIAZ, LOURDES M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B37 CALLE 1
Mailing Address - Street 2:PASEO LAS VISTAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5903
Mailing Address - Country:US
Mailing Address - Phone:787-370-0869
Mailing Address - Fax:
Practice Address - Street 1:B37 CALLE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5903
Practice Address - Country:US
Practice Address - Phone:787-370-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist