Provider Demographics
NPI:1275868887
Name:DIAZ FIGUEROA, EDUARDO MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:MANUEL
Last Name:DIAZ FIGUEROA
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 78
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715
Mailing Address - Country:US
Mailing Address - Phone:787-651-6673
Mailing Address - Fax:787-651-6519
Practice Address - Street 1:2931 AVE EMILIO FAGOT STE A
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3613
Practice Address - Country:US
Practice Address - Phone:787-651-6673
Practice Address - Fax:787-651-6519
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17708208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDQ202AMedicaid