Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 9169 | PR |
NPI | 1134180458 |
---|---|
Provider Name | Dr. Edgard O Diaz |
First Address | San Juan, PR 00922-1913 |
Second Address | Ponce, PR 00717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 22/01/2019 |