Provider Demographics
NPI:1508116120
Name:DIAZ DIAZ, MAYELA M (MD)
Entity Type:Individual
Prefix:
First Name:MAYELA
Middle Name:M
Last Name:DIAZ 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:M-4 COLINA BUENA VISTA
Mailing Address - Street 2:URB. LAS COLINAS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4926
Mailing Address - Country:US
Mailing Address - Phone:787-474-8282
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL PLAZA CARR 2
Practice Address - Street 2:OFC 910
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:874-748-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19077208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics