Provider Demographics
NPI:1538149000
Name:DIAZ MENDOZA, SILVINO (MD)
Entity type:Individual
Prefix:DR
First Name:SILVINO
Middle Name:
Last Name:DIAZ MENDOZA
Suffix:
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 21368
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1368
Mailing Address - Country:US
Mailing Address - Phone:787-250-0812
Mailing Address - Fax:787-753-2378
Practice Address - Street 1:AVE PONCE DE LEON
Practice Address - Street 2:PROFESSIONAL MEDICAL PLZA. SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1000
Practice Address - Country:US
Practice Address - Phone:787-250-0812
Practice Address - Fax:787-753-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9196207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038601200Medicaid
PR80803Medicare ID - Type Unspecified