Provider Demographics
NPI:1275693574
Name:SERVICIOS MEDICOS PROFESIONALES DOCTOR J. DIAZ CSP
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS PROFESIONALES DOCTOR J. DIAZ CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:TARECK
Authorized Official - Last Name:DIAZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-244-7348
Mailing Address - Street 1:CENTRO COOP
Mailing Address - Street 2:SUITE 5000 BOX 953
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0953
Mailing Address - Country:US
Mailing Address - Phone:787-868-0045
Mailing Address - Fax:787-868-0045
Practice Address - Street 1:2 CALLE COLON STE 9
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3167
Practice Address - Country:US
Practice Address - Phone:787-868-0045
Practice Address - Fax:787-868-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12986208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12986OtherLOCAL LICENSE
PR89930Medicare ID - Type Unspecified
G98589Medicare UPIN