Provider Demographics
NPI:1710041918
Name:DIAZ, LOURDES AMPARO (OD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:AMPARO
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:563 TRIGO
Mailing Address - Street 2:EL DORADO 5C
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-722-0215
Mailing Address - Fax:787-723-8783
Practice Address - Street 1:563 TRIGO
Practice Address - Street 2:EL DORADO 5C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-722-0215
Practice Address - Fax:787-723-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist