Provider Demographics
NPI:1235378464
Name:JANET DIAZ DENTAL MEDICAL DOCTOR PSC
Entity Type:Organization
Organization Name:JANET DIAZ DENTAL MEDICAL DOCTOR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-267-1269
Mailing Address - Street 1:URB. BUENE VISTA
Mailing Address - Street 2:C/AMAURY VERAY A-20
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-267-1269
Mailing Address - Fax:787-267-1269
Practice Address - Street 1:CENTRO COMERCIAL BARINOS
Practice Address - Street 2:LOCAL 2-A
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-267-1269
Practice Address - Fax:787-267-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty