Healthcare Provider Details

I. General information

NPI: 1306047774
Provider Name (Legal Business Name): LIDIA D DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CFSE ESCORIAL INDUSTRIAL PARK BO SAN ANTON
CAROLINA PR
00987
US

IV. Provider business mailing address

E7 CALLE MALAGA VISTA MAR MARINA ESTE
CAROLINA PR
00983-1507
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6850
  • Fax:
Mailing address:
  • Phone: 787-757-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number7281
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7281
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: