Provider Demographics
NPI:1306047774
Name:DIAZ, LIDIA D (MD)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:D
Last Name: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:E7 CALLE MALAGA
Mailing Address - Street 2:VISTA MAR MARINA ESTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1507
Mailing Address - Country:US
Mailing Address - Phone:787-757-6850
Mailing Address - Fax:
Practice Address - Street 1:CFSE ESCORIAL INDUSTRIAL PARK
Practice Address - Street 2:BO SAN ANTON
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-757-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR72812083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29592Medicare ID - Type Unspecified
PR28729DIMedicare UPIN