Healthcare Provider Details

I. General information

NPI: 1841116621
Provider Name (Legal Business Name): CQD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 EMETERIO BETANCES, EDIF. ACHILLA CABRERA, MAYAGUEZ
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

URB. PARAISO DE MAYAGUEZ, CALLE LEALTAD 118
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-436-4848
  • Fax:
Mailing address:
  • Phone: 787-436-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE DIAZ MIRANDA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-436-4848