Healthcare Provider Details

I. General information

NPI: 1568524353
Provider Name (Legal Business Name): DIBAZ ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOCTORS CENTER 305 ROAD #2
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 278
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-3322
  • Fax: 787-854-5234
Mailing address:
  • Phone: 787-854-3322
  • Fax: 787-854-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MANUEL G DIAZ LUGO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-854-3322