=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710278114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA DIAZ DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2011
-----------------------------------------------------
Last Update Date | 04/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE DEL PARQUE 411A PADA 23
-----------------------------------------------------
City | SANTURCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-722-4092
-----------------------------------------------------
Fax | 787-724-0320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE PARIS 243 PMB 1430
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-487-5332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2868
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------