Healthcare Provider Details

I. General information

NPI: 1548241052
Provider Name (Legal Business Name): RITA MARIA DIAZ MD FAAAA&I
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568-B JUAN J JIMENEZ
SAN JUAN PR
00919
US

IV. Provider business mailing address

568-B JUAN J JIMENEZ
SAN JUAN PR
00919
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-8939
  • Fax: 787-765-4418
Mailing address:
  • Phone: 787-763-8939
  • Fax: 787-765-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number3758
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: