| Doctor Name: | JOSE DIAZ |
| NPI Number: | 1396191813 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 71810 |
| Business Practice Address: | I10 Calle 6 Urb Tamarindo 1 San Lorenzo, PR - 00754 |
| Business Phone Number: | 7873405103 |
| Business Fax Number: | |
| Mailing Address: | J-9 Calle Flamboyan, Urb Bosque Llano SAN LORENZO |
| State: | PR |
| Postal Code: | 00754 |
| Phone Number: | 7872039985 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2016 |
| NPI Last Update Date: | 05/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 71810 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |