Healthcare Provider Details

I. General information

NPI: 1487251492
Provider Name (Legal Business Name): LEONARDO R DIAZ ZAYAS RDN, LND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON 1801 SANTURCE MEDICAL MALL SUITE 308
SAN JUAN PR
00909
US

IV. Provider business mailing address

819 CALLE PATRIA TIO
SAN JUAN PR
00924-2409
US

V. Phone/Fax

Practice location:
  • Phone: 787-214-6689
  • Fax:
Mailing address:
  • Phone: 787-214-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86148575
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2143
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: