Provider Demographics
NPI:1215095153
Name:DIAZ TROCHE, JUAN R SR (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:DIAZ TROCHE
Suffix:SR
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 1150
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1150
Mailing Address - Country:US
Mailing Address - Phone:787-834-2520
Mailing Address - Fax:787-833-6730
Practice Address - Street 1:CALLE PABLO MAIZ 13
Practice Address - Street 2:BO BARCELONA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-1150
Practice Address - Country:US
Practice Address - Phone:781-834-2520
Practice Address - Fax:787-833-6730
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
06530OtherCRUZ AZUL
3134OtherAMERICAN HEALTH
346771OtherMEDICAL CARD SYSTEM
20895OtherAMPR
5165OtherINTERNATIONAL MEDICAL CAR
PE2111OtherPAN AMERICAN LIFE
146530OtherBLUE CROSS BLUE SHIELD
06530OtherCRUZ AZUL
20895OtherAMPR