Provider Demographics
NPI:1548622202
Name:DIAZ, SUZETTE LYMARIE
Entity type:Individual
Prefix:MISS
First Name:SUZETTE
Middle Name:LYMARIE
Last Name:DIAZ
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 1:382 CALLE EMAJAGUILLA
Mailing Address - Street 2:LOS FLAMBOYANES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2782
Mailing Address - Country:US
Mailing Address - Phone:787-463-5882
Mailing Address - Fax:
Practice Address - Street 1:CALLE EMAJAGUILLA NO. 382
Practice Address - Street 2:URB. LOS FLAMBOYANES
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-463-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8743183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician