Provider Demographics
NPI:1962433326
Name:DIAZ, ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name: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:URB MONTEHIEDRA CALLE
Mailing Address - Street 2:FALCON NO 51
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-720-7954
Mailing Address - Fax:
Practice Address - Street 1:URB MONTEHIEDRA CALLE
Practice Address - Street 2:FALCON NO 51
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-720-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12064261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89572Medicare ID - Type UnspecifiedPROVIDER
PR0089572Medicare PIN