Provider Demographics
NPI:1902878614
Name:GONZALEZ DIAZ, MERBIL (MD)
Entity type:Individual
Prefix:DR
First Name:MERBIL
Middle Name:
Last Name:GONZALEZ DIAZ
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 1:351 AVE HOSTOS
Mailing Address - Street 2:MEDICAL EMPORIUM SUITE 309
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:787-805-7319
Mailing Address - Fax:
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM SUITE 309
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-805-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH45015Medicare UPIN
PR0084320Medicare ID - Type Unspecified