Healthcare Provider Details

I. General information

NPI: 1013910231
Provider Name (Legal Business Name): BERNARDO JOSE MARQUES DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LOMAS VERDES AVE. SUITE 208
SAN JUAN PR
00927-6638
US

IV. Provider business mailing address

310 LOMAS VERDES AVE. SUITE 208
SAN JUAN PR
00927-6638
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-3150
  • Fax: 787-767-0338
Mailing address:
  • Phone: 787-751-3150
  • Fax: 787-767-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11700
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: