Provider Demographics
NPI:1386484251
Name:DIAZ PEREZ, JAHAIRA MARIE
Entity type:Individual
Prefix:
First Name:JAHAIRA
Middle Name:MARIE
Last Name:DIAZ PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 1 R11
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4003
Mailing Address - Country:US
Mailing Address - Phone:787-391-3485
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1 R11
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4003
Practice Address - Country:US
Practice Address - Phone:787-391-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1314156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty