Provider Demographics
NPI:1386785608
Name:DIAZ VELAZQUEZ, LIANA IVONNE
Entity type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:IVONNE
Last Name:DIAZ VELAZQUEZ
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:PO BOX 801260
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1260
Mailing Address - Country:US
Mailing Address - Phone:787-366-3288
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 801260
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-1260
Practice Address - Country:US
Practice Address - Phone:787-366-3288
Practice Address - Fax:787-837-3717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR040099500Medicaid