Healthcare Provider Details

I. General information

NPI: 1285692236
Provider Name (Legal Business Name): JUANA DIAZ MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DEGETAU ESQUINA MUNOZ RIVERA #45
JUANA DIAZ PR
00795-0378
US

IV. Provider business mailing address

PO BOX 378
JUANA DIAZ PR
00795-0378
US

V. Phone/Fax

Practice location:
  • Phone: 787-837-3530
  • Fax: 787-837-3382
Mailing address:
  • Phone: 787-837-3530
  • Fax: 787-837-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number5253
License Number StatePR

VIII. Authorized Official

Name: DR. MARIA TERESA GARCIA
Title or Position: PRESIDENTE
Credential: M.D
Phone: 787-837-3530