Provider Demographics
NPI:1487204988
Name:DIAZ-ORTIZ, MYRNA E
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:E
Last Name:DIAZ-ORTIZ
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 1:11 VALLE ESCONDIDO # 1
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-8000
Mailing Address - Country:US
Mailing Address - Phone:787-409-0758
Mailing Address - Fax:
Practice Address - Street 1:11 VALLE ESCONDIDO # 1
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-8000
Practice Address - Country:US
Practice Address - Phone:787-409-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider