Healthcare Provider Details

I. General information

NPI: 1508116120
Provider Name (Legal Business Name): MAYELA M DIAZ DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLAZA CARR 2 OFC 910
BAYAMON PR
00959
US

IV. Provider business mailing address

M-4 COLINA BUENA VISTA URB. LAS COLINAS
TOA BAJA PR
00949-4926
US

V. Phone/Fax

Practice location:
  • Phone: 874-748-2827
  • Fax:
Mailing address:
  • Phone: 787-474-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19077
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number19077
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: