Healthcare Provider Details

I. General information

NPI: 1154376952
Provider Name (Legal Business Name): HENRY DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MARIO BRACHI NUM 9
COAMO PR
00769-0000
US

IV. Provider business mailing address

PO BOX 2156
COAMO PR
00769-2156
US

V. Phone/Fax

Practice location:
  • Phone: 787-803-3636
  • Fax: 787-825-4968
Mailing address:
  • Phone: 787-841-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12894
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: