Provider Demographics
NPI:1356496400
Name:DIAZ, HORTENSIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HORTENSIA
Middle Name:
Last Name:DIAZ
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 519
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0519
Mailing Address - Country:US
Mailing Address - Phone:787-266-3128
Mailing Address - Fax:787-893-5811
Practice Address - Street 1:URB. MENDEZ CALLE #2
Practice Address - Street 2:SUIT 5
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-266-3128
Practice Address - Fax:787-893-5811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9799208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics