Provider Demographics
NPI:1114121894
Name:DIAZ HERNANDEZ, JUAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:J
Last Name:DIAZ HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:293 CALLE VICENZA
Mailing Address - Street 2:EXTENTION COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4705
Mailing Address - Country:US
Mailing Address - Phone:787-981-8509
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:ASHFORD MEDICAL CENTER STE 505
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-596-7878
Practice Address - Fax:787-721-2204
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17169208600000X
FLME106431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery