Provider Demographics
NPI:1568559953
Name:DIAZ TORRES, JESUS ANTONIO (MT ASCP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ANTONIO
Last Name:DIAZ TORRES
Suffix:
Gender:M
Credentials:MT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30000
Mailing Address - Street 2:PMB 8001
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-8001
Mailing Address - Country:US
Mailing Address - Phone:787-816-2251
Mailing Address - Fax:787-816-2414
Practice Address - Street 1:CARR 638 KM 60 BO MIRAFLORES
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00616
Practice Address - Country:US
Practice Address - Phone:787-816-2251
Practice Address - Fax:787-816-2414
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3961246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30133Medicare ID - Type Unspecified