Provider Demographics
NPI:1265506331
Name:DIAZ-VARGAS, MANUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANGEL
Last Name:DIAZ-VARGAS
Suffix:
Gender:M
Credentials:MD
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 6477
Mailing Address - Street 2:SANTA ROSA UNIT
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5477
Mailing Address - Country:US
Mailing Address - Phone:787-740-0320
Mailing Address - Fax:787-740-6690
Practice Address - Street 1:66 SANTA CRUZ
Practice Address - Street 2:SUITE 407 INSTITUTO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-740-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97876Medicare ID - Type Unspecified
C78207Medicare UPIN