MEDICARE: DR. IVAN R FIGUEROA 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	208D00000X	General Practice Physician	10060	PR

General Provider Information

NPI Number	:	1518935477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN R FIGUEROA DIAZ M.D.

Provider Business Mailing Address
First Line	:	1277 CALLE 54 SE
Second Line	:	LA RIVIERA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3144
Country	:	US
Telephone Number	:	787-781-7512
Fax Number	:	787-781-8917

Provider Business Practice Location Address
First Line	:	1277 CALLE 54 SE LA RIVIERA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3144
Country	:	US
Telephone Number	:	787-781-7512
Fax Number	:	787-781-7512

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/20/2019

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