Healthcare Provider Details

I. General information

NPI: 1023077831
Provider Name (Legal Business Name): ANITA DIAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 AVE ASHFORD
SAN JUAN PR
00907-1511
US

IV. Provider business mailing address

PO BOX 11913
SAN JUAN PR
00922-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-2160
  • Fax:
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-999-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13534
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number13534
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13534
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: