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General NPI Number Information
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NPI Number | 1124091418
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Entity Type | Individual
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Provider Name | RAFAEL DIAZ RIVERA MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CONDO MEDICINA CENTER ALTOS CORREO RIO PIEDRAS OFICINA 704 CALLE ARZUAGA #112
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City | RIO PIEDRAS
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-645-9783
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE GRAN CANYON U2-4 PARK GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | LIC14134
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License Number State | PR
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