Healthcare Provider Details

I. General information

NPI: 1770791576
Provider Name (Legal Business Name): VICTOR J LLADO DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 CALLE RAFAEL LAMAR
SAN JUAN PR
00918-2117
US

IV. Provider business mailing address

374 CALLE RAFAEL LAMAR
SAN JUAN PR
00918-2117
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-7948
  • Fax: 787-759-9645
Mailing address:
  • Phone: 787-759-7948
  • Fax: 787-759-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4229
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: