Provider Demographics
NPI:1285692236
Name:JUANA DIAZ MEDICAL GROUP INC
Entity type:Organization
Organization Name:JUANA DIAZ MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-837-3530
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0378
Mailing Address - Country:US
Mailing Address - Phone:787-837-3530
Mailing Address - Fax:787-837-3382
Practice Address - Street 1:CALLE DEGETAU ESQUINA
Practice Address - Street 2:MUNOZ RIVERA #45
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0378
Practice Address - Country:US
Practice Address - Phone:787-837-3530
Practice Address - Fax:787-837-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5253302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087886OtherMEDICARE PROVIDER NUMBER