=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164407078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIO E DIEPPA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 12/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 271 DOMENECH ST
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-756-5685
-----------------------------------------------------
Fax | 787-763-7833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | F6 VIA BOGOTA
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-3087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-756-5685
-----------------------------------------------------
Fax | 787-763-7833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 6503
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------