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General NPI Number Information
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NPI Number | 1114121894
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Entity Type | Individual
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Provider Name | JUAN J DIAZ HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 29 CALLE WASHINGTON ASHFORD MEDICAL CENTER STE 505
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City | SAN JUAN
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State | PR
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Zip | 00907-1510
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Country | US
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Telephone | 787-596-7878
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Fax | 787-721-2204
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Provider Business Mailing Address
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Address Line | 293 CALLE VICENZA EXTENTION COLLEGE PARK
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City | SAN JUAN
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State | PR
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Zip | 00921-4705
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Country | US
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Telephone | 787-981-8509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 17169
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME106431
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License Number State | FL
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