Provider Demographics
NPI:1487874665
Name:DIAZ - SCHROEDER, ELSIE M (MD)
Entity type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:M
Last Name:DIAZ - SCHROEDER
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:PO BOX 6466
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6466
Mailing Address - Country:US
Mailing Address - Phone:787-436-2086
Mailing Address - Fax:
Practice Address - Street 1:CALLE SANTA MARIA M2
Practice Address - Street 2:AVE BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-436-2086
Practice Address - Fax:939-437-4037
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12260207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037447400Medicaid
PR20385OtherTRIPLE SSS