MEDICARE: DR. LUIS JAVIER DE LA ROSA DIAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4440	PR

General Provider Information

NPI Number	:	1164429833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS JAVIER DE LA ROSA DIAZ M.D.

Provider Business Mailing Address
First Line	:	1449 CALLE AMERICO SALAS BLDG II
Second Line	:	SUITE 201
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-724-4433
Fax Number	:	787-724-7170

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS BLDG II
Second Line	:	SUITE 201
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-724-4433
Fax Number	:	787-724-7170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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