Healthcare Provider Details

I. General information

NPI: 1568559953
Provider Name (Legal Business Name): JESUS ANTONIO DIAZ TORRES MT ASCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 638 KM 60 BO MIRAFLORES
ARECIBO PR
00616
US

IV. Provider business mailing address

PO BOX 30000 PMB 8001
SABANA HOYOS PR
00688-8001
US

V. Phone/Fax

Practice location:
  • Phone: 787-816-2251
  • Fax: 787-816-2414
Mailing address:
  • Phone: 787-816-2251
  • Fax: 787-816-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number3961
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: