Provider Demographics
NPI:1568524353
Name:DIBAZ ENTERPRISES
Entity Type:Organization
Organization Name:DIBAZ ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIAZ LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-3322
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-3322
Mailing Address - Fax:787-854-5234
Practice Address - Street 1:DOCTORS CENTER 305
Practice Address - Street 2:ROAD #2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3322
Practice Address - Fax:787-854-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty