Provider Demographics
NPI:1477317402
Name:DIAZ VELEZ, SEBASTIAN CONRADO
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:CONRADO
Last Name:DIAZ VELEZ
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:RR 7 BOX 17118
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8843
Mailing Address - Country:US
Mailing Address - Phone:787-209-1930
Mailing Address - Fax:
Practice Address - Street 1:CALLE NABORIA H15 HACIENDAS DEL CARIBE
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-209-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program