Provider Demographics
NPI:1205030988
Name:ZEQUEIRA DIAZ, JORGE J (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:J
Last Name:ZEQUEIRA DIAZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CC14 CALLE DAISY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6314
Mailing Address - Country:US
Mailing Address - Phone:787-504-1100
Mailing Address - Fax:787-287-6190
Practice Address - Street 1:CIRUGIA PEDIATRICA RCM
Practice Address - Street 2:HOSPITAL PEDIATRICO UNIVERSITARIO CENTRO MEDICO DE PR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17,8852086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery