Healthcare Provider Details

I. General information

NPI: 1215869243
Provider Name (Legal Business Name): LD DIAZ MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 AVE LUIS VIGOREAUX STE 344
GUAYNABO PR
00966-2715
US

IV. Provider business mailing address

404 CALLE REINA ISABEL
GUAYNABO PR
00969-3342
US

V. Phone/Fax

Practice location:
  • Phone: 787-308-4223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUZ D DIAZ GOMEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-308-4223