1609649854 NPI number — DIAZ MEDICAL SERVICE LCC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609649854 NPI number — DIAZ MEDICAL SERVICE LCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAZ MEDICAL SERVICE LCC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609649854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 BLVD DAVID CORDOVA TORRECH APT 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-908-0261
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONDOMINIO LAGO VISTA II
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-908-0261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SANTOS
Authorized Official First Name:
LEONOR
Authorized Official Middle Name:
DIAZ
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-908-0261

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 518106 . This is a "REGISTRO DEPARTAMENTO DE ESTADO DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com