Healthcare Provider Details

I. General information

NPI: 1588168850
Provider Name (Legal Business Name): HENRY XAVIER NIEVES DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/30/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL CENTER URB. ATENAS, CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

V3 CALLE HIGUERO QUINTAS DE VILLAMAR
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone: 787-478-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number21671
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21671
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: