Provider Demographics
NPI:1972590842
Name:DIAZ, RAFAEL ANGEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANGEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ANGEL
Other - Last Name:DIAZ MONTANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-4037
Mailing Address - Country:US
Mailing Address - Phone:787-757-0833
Mailing Address - Fax:787-757-0833
Practice Address - Street 1:SANCHEZ OSORIO AVE 5H
Practice Address - Street 2:VILLA FONTANA PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-757-0833
Practice Address - Fax:787-757-0833
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
500320EOtherMMM
581OtherPALIC
6300051OtherHUMANA INS
062748OtherCA
G30005OtherHUMANA HEALTH
20113OtherPREFERRED
21684OtherSSS
6300051OtherHUMANA INS
500320EOtherMMM