Provider Demographics
NPI:1265560387
Name:DELIZ, ELDRA LETICIA
Entity type:Individual
Prefix:MRS
First Name:ELDRA
Middle Name:LETICIA
Last Name:DELIZ
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 1:546 CALLE LUIS A MORALES
Mailing Address - Street 2:ESTANCIAS DEL GOLF
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-232-6510
Mailing Address - Fax:
Practice Address - Street 1:546 CALLE LUIS A MORALES
Practice Address - Street 2:ESTANCIAS DEL GOLF
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-232-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist