Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 6700 | PR |
NPI | 1083732085 |
---|---|
Provider Name | Dr. Candido Diaz Diaz SR. |
First Address | Caguas, PR 00726-6825 |
Second Address | Caguas, PR 00725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 22/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C77633 | (02) | PR |