Provider Demographics
NPI:1336460716
Name:DIAZ-POU, MARLEN NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:NICOLE
Last Name:DIAZ-POU
Suffix:
Gender:F
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 194690
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4690
Mailing Address - Country:US
Mailing Address - Phone:787-406-2520
Mailing Address - Fax:
Practice Address - Street 1:320 CALLE REY FELIPE
Practice Address - Street 2:LA VILLA DE TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3255
Practice Address - Country:US
Practice Address - Phone:787-406-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics