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General NPI Number Information
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NPI Number | 1568433852
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Entity Type | Individual
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Provider Name | MIGUEL A LOPEZ-DIAZ MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 1801 AVE PONCE DE LEON SANTURCE MEDICAL MALL, OFICE 406
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City | SAN JUAN
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State | PR
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Zip | 00909-1900
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Country | US
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Telephone | 787-728-5967
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Fax |
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Provider Business Mailing Address
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Address Line | 243 CALLE PARIS PMB 1689
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City | SAN JUAN
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State | PR
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Zip | 00917-3632
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Country | US
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Telephone | 787-728-5967
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Fax | 787-728-5967
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5779
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License Number State | PR
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