Provider Demographics
NPI:1124749361
Name:PAGAN-DIAZ, IDELIZ (RDN)
Entity type:Individual
Prefix:
First Name:IDELIZ
Middle Name:
Last Name:PAGAN-DIAZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 7551
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9337
Mailing Address - Country:US
Mailing Address - Phone:787-421-8958
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL JARDINES #9
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3117
Practice Address - Country:US
Practice Address - Phone:787-421-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered