Provider Demographics
NPI:1558497990
Name:DIAZ, EDDA NELIDA (RPH)
Entity type:Individual
Prefix:MRS
First Name:EDDA
Middle Name:NELIDA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CALLE ZIRCONIA
Mailing Address - Street 2:LOS PRADOS SUR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9649
Mailing Address - Country:US
Mailing Address - Phone:787-278-2606
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:SAN JUAN VA MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-5714
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist