Healthcare Provider Details

I. General information

NPI: 1447149265
Provider Name (Legal Business Name): JUAN JAVIER GONZALEZ DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 CALLE GOLONDRINA
DORADO PR
00646-9413
US

IV. Provider business mailing address

228 CALLE GOLONDRINA LOS MONTES
DORADO PR
00646-9413
US

V. Phone/Fax

Practice location:
  • Phone: 787-951-8025
  • Fax:
Mailing address:
  • Phone: 787-951-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25126
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: