Healthcare Provider Details

I. General information

NPI: 1225033319
Provider Name (Legal Business Name): DIANA DE LA PAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DR.CUETO ST
UTUADO PR
00641-1390
US

IV. Provider business mailing address

PO BOX 1390
UTUADO PR
00641-1390
US

V. Phone/Fax

Practice location:
  • Phone: 787-814-0683
  • Fax: 787-894-8860
Mailing address:
  • Phone: 787-814-4521
  • Fax: 787-814-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8478
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: