Provider Demographics
NPI:1467091223
Name:TERREFORTE-DIAZ, JUAN F
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:TERREFORTE-DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BALDORIOTY 165 NORTE
Mailing Address - Street 2:BUZON #2
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:939-545-0522
Mailing Address - Fax:939-545-0700
Practice Address - Street 1:CALLE BALDORIOTY 165 NORTE
Practice Address - Street 2:BUZON #2
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:939-545-0522
Practice Address - Fax:939-545-0700
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor