Healthcare Provider Details

I. General information

NPI: 1609869338
Provider Name (Legal Business Name): JANET DIAZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 368 KM 12.6 BO. SUSUA BAJA
YAUCO PR
00698
US

IV. Provider business mailing address

AMAURY VERAY A-20 URB. BUENA VISTA
YAUCO PR
00698-3519
US

V. Phone/Fax

Practice location:
  • Phone: 787-267-1269
  • Fax: 787-267-1269
Mailing address:
  • Phone: 787-267-1269
  • Fax: 787-267-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2407
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: