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General NPI Number Information
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NPI Number | 1548876121
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Entity Type | Individual
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Provider Name | MERVIN DE GUZMAN DIAZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2020
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 355 CALLE FONT MARTELO
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City | HUMACAO
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State | PR
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Zip | 00791-3249
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Country | US
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Telephone | 787-852-0768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 59
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City | FAJARDO
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State | PR
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Zip | 00738-0059
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Country | US
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Telephone | 787-718-2715
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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 | 24685
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License Number State | PR
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