Healthcare Provider Details

I. General information

NPI: 1295251148
Provider Name (Legal Business Name): ANDRES E CALVO DIAZ MD,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 10/31/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVENIDA LAUREL URB SANTA JUANITA
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 60327
BAYAMON PR
00960-6032
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number22355
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number22355
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: