Healthcare Provider Details

I. General information

NPI: 1831087402
Provider Name (Legal Business Name): AESTHETIC OPHTHALMOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/29/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AVE PEDRO ALBIZU CAMPOS
AGUADILLA PR
00603-5724
US

IV. Provider business mailing address

PO BOX 2033
AGUADILLA PR
00605-2033
US

V. Phone/Fax

Practice location:
  • Phone: 787-422-6349
  • Fax:
Mailing address:
  • Phone: 787-422-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LILLIAM DIAZ
Title or Position: PRESIDENTA
Credential: MD
Phone: 787-422-6349