Provider Demographics
NPI:1154376952
Name:DIAZ, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
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 2156
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2156
Mailing Address - Country:US
Mailing Address - Phone:787-841-0525
Mailing Address - Fax:
Practice Address - Street 1:CALLE MARIO BRACHI NUM 9
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-0000
Practice Address - Country:US
Practice Address - Phone:787-803-3636
Practice Address - Fax:787-825-4968
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12894207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRM000396OtherPLAN MENONITA
PRP00103108OtherPALMETTO
PR7690016OtherHUMANA INSURANCE
PR7690016OtherHUMANA REFORMA
PR061763OtherCRUZ AZUL DE PUERTO RICO
PR4512894OtherUIA
PR600865OtherMEDICARE Y MUCHO MAS
PR7690016OtherHUMANA HEALTH PLAN
PR20481OtherTRIPLE S
PR212645OtherPREFERRED HEALTH
PR7789OtherFIRST MEDICAL
PR38385OtherPROSSAM
PRPE4134OtherPALIC PROVIDER
PR20481OtherTRIPLE S
PR7690016OtherHUMANA INSURANCE