MEDICARE: DR. PORFIRIO ERNESTO DIAZ 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	207RC0000X	Cardiovascular Disease Physician	6921	PR

General Provider Information

NPI Number	:	1992727713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PORFIRIO ERNESTO DIAZ MD

Provider Business Mailing Address
First Line	:	#1021 GENERAL DEL VALLE URB. DELICIAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3722
Country	:	US
Telephone Number	:	787-731-2123
Fax Number	:

Provider Business Practice Location Address
First Line	:	#1021 GENERAL DEL VALLE URB. DELICIAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3722
Country	:	US
Telephone Number	:	787-731-2123
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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