Healthcare Provider Details

I. General information

NPI: 1851420004
Provider Name (Legal Business Name): MANUEL A. DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF CAPARRA GALLERY AVE. GONZALES GIUSTI NO. 170 SUITE 300
GUAYNABO PR
00966-2515
US

IV. Provider business mailing address

MANSIONS OF GARDEN HILLS COND. APT. 1-G 3RD ST. TOWER SOUTH
GUAYNABO PR
00966-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-531-6840
  • Fax: 787-782-4268
Mailing address:
  • Phone: 787-782-4268
  • Fax: 787-782-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number8649
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: