Provider Demographics
NPI:1508995259
Name:RIOS-DIAZ, MARIA ELENA
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:RIOS-DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 CALLE GUANAJIBO
Mailing Address - Street 2:CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6035
Mailing Address - Country:US
Mailing Address - Phone:787-646-3230
Mailing Address - Fax:787-767-1290
Practice Address - Street 1:H16 CALLE SAN FELIPE
Practice Address - Street 2:NOTRE DAME
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3910
Practice Address - Country:US
Practice Address - Phone:787-646-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11732261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11732OtherSTATE MD LICENSE ID
PRBR4445501OtherDEA ID