Healthcare Provider Details

I. General information

NPI: 1568434850
Provider Name (Legal Business Name): ANA A PADRO- DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 AVE MUNOZ RIVERA URB VILLA GRILLASCA
PONCE PR
00717-0635
US

IV. Provider business mailing address

1520 CALLE EMPERATRIZ URB VALLE REAL
PONCE PR
00716-0502
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8545
  • Fax: 787-840-8545
Mailing address:
  • Phone: 787-840-8545
  • Fax: 787-840-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number6488
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number6488
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: