Healthcare Provider Details

I. General information

NPI: 1669086740
Provider Name (Legal Business Name): LUIS MIGUEL DIAZ COLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERNANDEZ CARRION CARR #2 INTERSECCION 668 URB. ATENAS
MANATI PR
00674-1142
US

IV. Provider business mailing address

PO BOX 560
HATILLO PR
00659-0560
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax: 787-621-3266
Mailing address:
  • Phone: 787-246-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15393I
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: