MEDICARE: DR. JUAN DENIZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	6262	PR

General Provider Information

NPI Number	:	1205811692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN DENIZ MD

Provider Business Mailing Address
First Line	:	PO BOX 192373
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-2373
Country	:	US
Telephone Number	:	787-268-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 AVE PONCE DE LEON
Second Line	:	SANTURCE MEDICAL MALL SUITE 307
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1900
Country	:	US
Telephone Number	:	787-268-7557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/09/2007

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