Healthcare Provider Details

I. General information

NPI: 1447055660
Provider Name (Legal Business Name): NICOLE SHAIRY DIAZ ALICEA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE SHAIRY DIAZ ALICEA

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AUXILIO MUTUO, AVE PONCE DE LEON STOP 37 1/2
SAN JUAN PR
00919
US

IV. Provider business mailing address

URB TURABO GARDENS CALLE 18 Z-11
CAGUAS PR
00727
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-246-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number85973
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: