Provider Demographics
NPI:1447214192
Name:DIAZ-MAISONET, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:DIAZ-MAISONET
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:URBANIZACION BUCARE
Mailing Address - Street 2:TOPACIO 2055
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5110
Mailing Address - Country:US
Mailing Address - Phone:787-272-8421
Mailing Address - Fax:
Practice Address - Street 1:AVENDIA PONCE DE LEON 706
Practice Address - Street 2:PARADA 37
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-5555
Practice Address - Fax:787-763-3646
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79350Medicare UPIN
Z4Z18Medicare ID - Type Unspecified