Provider Demographics
NPI:1972754935
Name:DIAZ, ANGEL L
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:O'FARRILL
Other - Middle Name:
Other - Last Name:AMBULANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0208
Mailing Address - Country:US
Mailing Address - Phone:787-310-3860
Mailing Address - Fax:787-292-3912
Practice Address - Street 1:CARR 176 KM 11.2 CAM. RAMAL LOS GUAYABOS
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-310-3860
Practice Address - Fax:787-292-3912
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB 3453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR56979Medicare PIN