Provider Demographics
NPI:1114013778
Name:DIAZ SELLES, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:DIAZ SELLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E 3 CALLE 7 PASEO MAYOR LOS PASEOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-743-2288
Mailing Address - Fax:
Practice Address - Street 1:HIMA
Practice Address - Street 2:OFIC. 128
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400307OtherMMM
PR0400742OtherHUMANA
PR4302OtherINTERNATIONAL MEDICAL CAR
PR069981OtherCRUZ AZUL
PR81949DIOtherTRIPLE S
PR069981OtherCRUZ AZUL
PRE44007Medicare UPIN