Provider Demographics
NPI:1992906275
Name:CLINICA DIAZ PSC
Entity type:Organization
Organization Name:CLINICA DIAZ PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADJA
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-1053
Mailing Address - Street 1:7813 NAZARET URB SANTA MARIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1006
Mailing Address - Country:US
Mailing Address - Phone:787-840-1053
Mailing Address - Fax:787-842-6525
Practice Address - Street 1:7813 NAZARET URB SANTA MARIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1006
Practice Address - Country:US
Practice Address - Phone:787-840-1053
Practice Address - Fax:787-842-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12997207R00000X
PR14444208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty