Healthcare Provider Details

I. General information

NPI: 1689786170
Provider Name (Legal Business Name): JOSE J DIAZ-ABASCAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A 1 MUNOZ RIVERA SUITE 302 HIMA SURGICENTER
CAGUAS PR
00726-0870
US

IV. Provider business mailing address

PO BOX 870
CAGUAS PR
00726-0870
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-3087
  • Fax: 787-746-4840
Mailing address:
  • Phone: 787-744-3087
  • Fax: 787-746-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2098
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: