Healthcare Provider Details

I. General information

NPI: 1023052719
Provider Name (Legal Business Name): CLEMENTE DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY PEDIATRIC HOSPITAL DEPARTMENT OF PEDIATRICS OFFICE 1A-29 1ST FLOOR
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

UNIVERSITY PEDIATRIC HOSPITAL DEPARTMENT OF PEDIATRICS PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4010
  • Fax: 787-777-3227
Mailing address:
  • Phone: 787-756-4010
  • Fax: 787-777-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1103X
TaxonomyResearch Study Abstracter/Coder
License Number6723
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: