Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 13534 | PR |
N | 208000000X | Pediatrician | 13534 | PR |
NPI | 1023077831 |
---|---|
Provider Name | Dr. Anita Diaz |
First Address | San Juan, PR 00922-1913 |
Second Address | San Juan, PR 00907-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 17/01/2019 |