Provider Demographics
NPI:1699979401
Name:POLICLINICA DR. MANUEL E. DIAZ SOTO
Entity type:Organization
Organization Name:POLICLINICA DR. MANUEL E. DIAZ SOTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAZ SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-0045
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-7003
Mailing Address - Country:US
Mailing Address - Phone:787-868-0045
Mailing Address - Fax:787-868-0045
Practice Address - Street 1:CARR. 111 KM 24.6 BO. ASOMANTE
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-7003
Practice Address - Country:US
Practice Address - Phone:787-868-0045
Practice Address - Fax:787-868-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10928171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083165Medicare ID - Type UnspecifiedGENERALISTA