Provider Demographics
NPI:1184816399
Name:DIAZ, EMILIO (MT)
Entity Type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50384
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0384
Mailing Address - Country:US
Mailing Address - Phone:787-784-0813
Mailing Address - Fax:787-795-5330
Practice Address - Street 1:S15 CALLE LEALTAD
Practice Address - Street 2:LEVITTOWN STA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4611
Practice Address - Country:US
Practice Address - Phone:787-784-0813
Practice Address - Fax:787-795-5330
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5043246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other