Healthcare Provider Details

I. General information

NPI: 1093672248
Provider Name (Legal Business Name): LOURDES DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANSIONES DE LOS CEDROS # 33 CALLE YAGRUMO
CAYEY PR
00736
US

IV. Provider business mailing address

MANSIONES DE LOS CEDROS # 33 CALLE YAGRUMO
CAYEY PR
00736
US

V. Phone/Fax

Practice location:
  • Phone: 787-595-0224
  • Fax:
Mailing address:
  • Phone: 787-595-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12250715
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: