MEDICARE: JOEL EMILIO DIAZ-PORTORREAL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1255948329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL EMILIO DIAZ-PORTORREAL

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4200
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	02/09/2026

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