Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 26095 | PR |
Y | 111NI0900X | Internist | 26095 | PR |
NPI | 1003016775 |
---|---|
Provider Name | Dr. Antonio Luis Diaz |
First Address | San Juan, PR 00926-0000 |
Second Address | San Juan, PR 00926-9570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 03/05/2010 |