Healthcare Provider Details

I. General information

NPI: 1962193524
Provider Name (Legal Business Name): DIANIRIS ASTACIO-RODRIGUEZ BACHELOR'S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA IND REPARADA 2
PONCE PR
00716-2347
US

IV. Provider business mailing address

HOSPITAL PEDIATRICO UNIVERSITARIO, CENTRO MEDICO CARRETERA 22
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax:
Mailing address:
  • Phone: 787-474-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17495
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: