Provider Demographics
NPI:1700936663
Name:DIAZ, VICTOR F (RPH)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:F
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CALLE BETANCES
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2949
Mailing Address - Country:US
Mailing Address - Phone:787-894-2118
Mailing Address - Fax:787-894-2038
Practice Address - Street 1:22 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2949
Practice Address - Country:US
Practice Address - Phone:787-894-2118
Practice Address - Fax:787-894-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR02047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist