Healthcare Provider Details

I. General information

NPI: 1114938271
Provider Name (Legal Business Name): DIEGO SANZ DE LA PENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 206 AUXILIO MUTUO TOWER
SAN JUAN PR
00917
US

IV. Provider business mailing address

CAMINO LAS PALMAS C-16 LOS PASEOS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-7370
  • Fax: 787-751-7470
Mailing address:
  • Phone: 787-751-7370
  • Fax: 787-751-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7410
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: