Healthcare Provider Details

I. General information

NPI: 1427133990
Provider Name (Legal Business Name): CLARA REYES DIAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 31.9 BO. BAJURA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

E30 CAMINIO DE BEGONIA ENRAMADA
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-0124
  • Fax: 787-883-7645
Mailing address:
  • Phone: 787-784-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6920
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number6920
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: