MEDICARE: DR. ROSA ISABEL DIAZ-CONDE D.M.D.

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	1223G0001X	General Practice Dentistry	D1342	PR

General Provider Information

NPI Number	:	1659426278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSA ISABEL DIAZ-CONDE D.M.D.

Provider Business Mailing Address
First Line	:	1814 GLASGOW
Second Line	:	COLLEGE PARK
City	:	SAN JUAN
State	:	PR
Zip	:	00921-4814
Country	:	US
Telephone Number	:	787-758-8510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 GLASGOW
Second Line	:	COLLEGE PARK
City	:	SAN JUAN
State	:	PR
Zip	:	00921-4814
Country	:	US
Telephone Number	:	787-758-8510
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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