Healthcare Provider Details

I. General information

NPI: 1831309541
Provider Name (Legal Business Name): DAMARIS DIAZ MORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 AVE. ANTONIO PRINCIPE PLAZA PRADERA EDIF.D SUITE2 URB.FRONTERAS DE BAYAMON
BAYAMON PR
00960-0000
US

IV. Provider business mailing address

PO BOX 1513
SABANA SECA PR
00952-1513
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-1996
  • Fax: 787-998-1996
Mailing address:
  • Phone: 787-587-2216
  • Fax: 787-998-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15665
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: