Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2656 | PR |
NPI | 1003803693 |
---|---|
Provider Name | Dr. Magda S. Diaz |
First Address | Guaynabo, PR 00970-0054 |
Second Address | Vega Baja, PR 00693-4453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 07/01/2009 |