Provider Demographics
NPI:1083127609
Name:OCASIO DIAZ, JOEL (LDN)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:OCASIO DIAZ
Suffix:
Gender:M
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PASEO ANDALUZ # V-7
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-3048
Mailing Address - Country:US
Mailing Address - Phone:787-559-4801
Mailing Address - Fax:
Practice Address - Street 1:302 CARR. 3 KM 82.5
Practice Address - Street 2:HUMACAO SHOPPING PLAZA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4713
Practice Address - Country:US
Practice Address - Phone:787-559-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2034133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered