Healthcare Provider Details

I. General information

NPI: 1699139337
Provider Name (Legal Business Name): ROBERTO BENJAMIN KUTCHER-DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERTO BENJAMIN KUTCHER-DIAZ M.D.

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 304
SAN JUAN PR
00917-5025
US

IV. Provider business mailing address

267 CALLE SAN JORGE APT 11B
SAN JUAN PR
00912-3351
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-1817
  • Fax:
Mailing address:
  • Phone: 787-590-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number294518
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21257
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number322920-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0102774
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number294518
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number322920-01
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number21257
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: