Healthcare Provider Details

I. General information

NPI: 1730084922
Provider Name (Legal Business Name): JAIME JOSE DIAZ SANTIAGO D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CALLE EUGENIO MARIA DE HOSTOS BO CAMPANILLAS
TOA BAJA PR
00949
US

IV. Provider business mailing address

234 CALLE EUGENIO MARIA DE HOSTOS BO CAMPANILLAS
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-321-2990
  • Fax:
Mailing address:
  • Phone: 787-321-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1179
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: