Healthcare Provider Details

I. General information

NPI: 1083127609
Provider Name (Legal Business Name): JOEL OCASIO DIAZ LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CARR. 3 KM 82.5 HUMACAO SHOPPING PLAZA
HUMACAO PR
00791-4713
US

IV. Provider business mailing address

254 PASEO ANDALUZ # V-7
SAN LORENZO PR
00754-3048
US

V. Phone/Fax

Practice location:
  • Phone: 787-559-4801
  • Fax:
Mailing address:
  • Phone: 787-559-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2034
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2034
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: