Provider Demographics
NPI:1154351161
Name:BUXO DIAZ, YADIRA I (MD)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:I
Last Name:BUXO DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-0777
Mailing Address - Country:US
Mailing Address - Phone:787-732-4123
Mailing Address - Fax:
Practice Address - Street 1:ROAD 173 KM 21.1
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-0777
Practice Address - Country:US
Practice Address - Phone:787-732-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6127208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR027582Medicare ID - Type Unspecified
PRE30429Medicare UPIN