JUAN R DIAZ TROCHE CIRUJANOS CSP

Provider Demographics

• NPI: 1437120979
• Name: JUAN R DIAZ TROCHE CIRUJANOS CSP
• Entity Type: Organization
• Organization Name: JUAN R DIAZ TROCHE CIRUJANOS CSP
• Authorized Official - Title/Position: PRESIDENTE ADMINISTINDO
• Authorized Official - Prefix: DR
• Authorized Official - First Name: JUAN
• Authorized Official - Middle Name: R
• Authorized Official - Last Name: DIAZ TROCHE
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 787-834-2520
• Mailing Address - Street 1: PO BOX 1150
• Mailing Address - City: MAYAGUEZ
• Mailing Address - State: PR
• Mailing Address - Zip Code: 00681-1150
• Mailing Address - Country: US
• Mailing Address - Phone: 787-834-2520
• Mailing Address - Fax: 787-833-6730
• Practice Address - Street 1: 13 CALLE PABLO MAIZ
• Practice Address - Street 2: BO BARCELONA
• Practice Address - City: MAYAGUEZ
• Practice Address - State: PR
• Practice Address - Zip Code: 00680-4838
• Practice Address - Country: US
• Practice Address - Phone: 787-834-2520
• Practice Address - Fax: 787-833-6730
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-02-01
• Last Update Date: 2011-10-26

Provider Licenses

State	License ID	Taxonomies
PR	4677	208600000X
PR	4610	208600000X
PR	11067	208600000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	=========	Other	SERV SALUD BELLA VISTA
	=========	Other	PAN AMERICAN LIFE
	=========	Other	MAPFRE CROW
	=========	Other	AETNA
	=========	Other	TRICARE
	=========	Other	UTI UNION TRAB 2NDE
	=========	Other	AARP
PR	=========	Other	AETNA
	=========	Other	SSS
	=========	Other	MCS MCS REFORMA MCS CASSI
	=========	Other	FIRST PLUS IMC
	=========	Other	ADM DE ACEIDERTS ACAA
	=========	Other	AMERICAN HEALTH
	=========	Other	GHI
	=========	Other	CSEU
	=========	Other	CRUZ AZEIL DE PR
	=========	Other	MMM
	=========	Other	PCA HUMANA
	=========	Other	UNION AAUDICHS UIA
	=========	Other	PCA HUMANA
	=========	Other	UNION AAUDICHS UIA