Healthcare Provider Details

I. General information

NPI: 1164407078
Provider Name (Legal Business Name): JULIO E DIEPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 DOMENECH ST
SAN JUAN PR
00918
US

IV. Provider business mailing address

F6 VIA BOGOTA
BAYAMON PR
00961-3087
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-5685
  • Fax: 787-763-7833
Mailing address:
  • Phone: 787-756-5685
  • Fax: 787-763-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number6503
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: