Provider Demographics
NPI:1508957630
Name:DIAZ BAEZ, SORIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SORIA
Middle Name:L
Last Name:DIAZ BAEZ
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 1:7813 CALLE NAZARET
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1006
Mailing Address - Country:US
Mailing Address - Phone:787-840-1053
Mailing Address - Fax:787-987-8042
Practice Address - Street 1:7813 CALLE NAZARET
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1006
Practice Address - Country:US
Practice Address - Phone:787-840-1053
Practice Address - Fax:787-987-8042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13370208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice