Provider Demographics
NPI:1235240789
Name:HOTESSE DIAZ, TANIA ANDREA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:ANDREA
Last Name:HOTESSE DIAZ
Suffix:
Gender:F
Credentials:
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 846
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0846
Mailing Address - Country:US
Mailing Address - Phone:787-880-1020
Mailing Address - Fax:787-880-1010
Practice Address - Street 1:51 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4418
Practice Address - Country:US
Practice Address - Phone:787-880-1020
Practice Address - Fax:787-880-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4928208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD32942Medicare UPIN
PR27105Medicare ID - Type Unspecified