Healthcare Provider Details

I. General information

NPI: 1710278114
Provider Name (Legal Business Name): ERIKA DIAZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DEL PARQUE 411A PADA 23
SANTURCE PR
00912
US

IV. Provider business mailing address

CALLE PARIS 243 PMB 1430
SAN JUAN PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-4092
  • Fax: 787-724-0320
Mailing address:
  • Phone: 787-487-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2868
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: