Healthcare Provider Details

I. General information

NPI: 1295984029
Provider Name (Legal Business Name): LILLIAM DIAZ VELEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE MERCEDES MORENO
AGUADILLA PR
00603-5152
US

IV. Provider business mailing address

PO BOX 968
AGUADILLA PR
00605-0968
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-6370
  • Fax: 787-882-6373
Mailing address:
  • Phone: 787-882-7766
  • Fax: 787-882-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17,976
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number17976
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: