Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 279494 | NY |
Y | 207PP0204X | Pediatric Emergency Physician | 21580 | PR |
NPI | 1154686236 |
---|---|
Provider Name | Dr. Juan C Zequeira Diaz |
First Address | Bayamon, PR 00960-0426 |
Second Address | Bayamon, PR 00959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 27/01/2021 |