Healthcare Provider Details

I. General information

NPI: 1598451544
Provider Name (Legal Business Name): CORALLE Y ESCODA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
SAN JUAN PR
00926-5067
US

IV. Provider business mailing address

UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
SAN JUAN PR
00926-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-758-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: