Healthcare Provider Details

I. General information

NPI: 1598396129
Provider Name (Legal Business Name): DIEGO JOSE DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO EDIF CADILLA OFICINA 405
BAYAMON PR
00961-7033
US

IV. Provider business mailing address

100 PASEO SAN PABLO EDIF CADILLA OFICINA 405
BAYAMON PR
00961-7033
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-5655
  • Fax: 787-979-1179
Mailing address:
  • Phone: 787-269-5655
  • Fax: 787-979-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23690
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: