Provider Demographics
NPI:1699139337
Name:KUTCHER-DIAZ, ROBERTO BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:BENJAMIN
Last Name:KUTCHER-DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:BENJAMIN
Other - Last Name:KUTCHER-DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:267 CALLE SAN JORGE APT 11B
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3351
Mailing Address - Country:US
Mailing Address - Phone:787-590-1817
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 304
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5025
Practice Address - Country:US
Practice Address - Phone:787-590-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2945182085R0202X, 2085R0204X
PR212572085R0202X, 2085R0204X
NY322920-012085R0202X, 2085R0204X
MDD01027742085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology