Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 511 | PR |
NPI | 1144474560 |
---|---|
Provider Name | Mercedes Mayra Diaz |
First Address | Mercedita, PR 00715-0374 |
Second Address | Ponce, PR 00716-2347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2008 |
Last Update Date | 12/11/2008 |