Healthcare Provider Details

I. General information

NPI: 1336460716
Provider Name (Legal Business Name): MARLEN NICOLE DIAZ-POU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CALLE REY FELIPE LA VILLA DE TORRIMAR
GUAYNABO PR
00969-3255
US

IV. Provider business mailing address

PO BOX 194690
SAN JUAN PR
00919-4690
US

V. Phone/Fax

Practice location:
  • Phone: 787-406-2520
  • Fax:
Mailing address:
  • Phone: 787-406-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20747
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: