Healthcare Provider Details

I. General information

NPI: 1952391336
Provider Name (Legal Business Name): JUAN GONZALEZ DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOCAL AA 5 LOIZA VALLEY SHOPPING CENTER LOIZA VALLEY
CANOVANAS PR
00729
US

IV. Provider business mailing address

267 CALLE SIERRA MORENA PMB #330
SAN JUAN PR
00926-5539
US

V. Phone/Fax

Practice location:
  • Phone: 787-886-5506
  • Fax: 787-876-4116
Mailing address:
  • Phone: 787-886-5506
  • Fax: 787-876-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number07130
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: