Provider Demographics
NPI:1427133990
Name:DIAZ, CLARA REYES (MD)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:REYES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:E30 CAMINIO DE BEGONIA
Mailing Address - Street 2:ENRAMADA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-784-2751
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 31.9
Practice Address - Street 2:BO. BAJURA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-0124
Practice Address - Fax:787-883-7645
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6920208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28808OtherIPA