Healthcare Provider Details

I. General information

NPI: 1992626121
Provider Name (Legal Business Name): MGDP INFECTOLOGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CARR 2 STE 6
MANATI PR
00674-5399
US

IV. Provider business mailing address

600 CARR 2 STE 6
MANATI PR
00674-5399
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-6334
  • Fax:
Mailing address:
  • Phone: 787-612-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIE GLORIA DIAZ
Title or Position: INFECTOLOGIST
Credential: MD
Phone: 787-612-6334