Healthcare Provider Details

I. General information

NPI: 1134937923
Provider Name (Legal Business Name): DAMARITH DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 07/31/2025
Reactivation Date: 07/28/2026

III. Provider practice location address

PO BOX 1535
JUNCOS PR
00777-1535
US

IV. Provider business mailing address

PO BOX 1535
JUNCOS PR
00777-1535
US

V. Phone/Fax

Practice location:
  • Phone: 787-235-2477
  • Fax:
Mailing address:
  • Phone: 787-235-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25145
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: