Doctor Name: | DR. ISMAEL ENRIQUE DIAZ |
NPI Number: | 1972931129 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 18599 |
Business Practice Address: | 130 Calle Carite Urb. Lago Alto Trujillo Alto, PR - 00976 |
Business Phone Number: | 7877480450 |
Business Fax Number: | |
Mailing Address: | Hx15 Calle 253, Urb Country Club 3ra Ext CAROLINA |
State: | PR |
Postal Code: | 00982 |
Phone Number: | 7876305066 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2013 |
NPI Last Update Date: | 07/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 18599 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |