Healthcare Provider Details

I. General information

NPI: 1174828412
Provider Name (Legal Business Name): DIAZ BONET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 55.1 BO PALENQUE
BARCELONETA PR
00617
US

IV. Provider business mailing address

P O BOX 1173
FLORIDA PR
00650-1173
US

V. Phone/Fax

Practice location:
  • Phone: 787-600-0321
  • Fax:
Mailing address:
  • Phone: 787-600-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHL231A
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: MRS. ANELIE BONET
Title or Position: VICE PRESIDENT
Credential: LCDA
Phone: 787-600-0321