Healthcare Provider Details

I. General information

NPI: 1992906275
Provider Name (Legal Business Name): CLINICA DIAZ PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7813 NAZARET URB SANTA MARIA
PONCE PR
00717-1006
US

IV. Provider business mailing address

7813 NAZARET URB SANTA MARIA
PONCE PR
00717-1006
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-1053
  • Fax: 787-842-6525
Mailing address:
  • Phone: 787-840-1053
  • Fax: 787-842-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12997
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14444
License Number StatePR

VIII. Authorized Official

Name: MRS. NADJA DIAZ BAEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-840-1053