Provider Demographics
NPI:1598753048
Name:DIAZ, ILIAN Y (OD)
Entity Type:Individual
Prefix:DR
First Name:ILIAN
Middle Name:Y
Last Name:DIAZ
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:CIUDAD JARDIN #79 CALLE BARCELONA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-744-6021
Mailing Address - Fax:787-744-6022
Practice Address - Street 1:200 CARR 31 SUITE 10
Practice Address - Street 2:JUNCOS PLAZA
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-5000
Practice Address - Fax:787-734-5000
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2018-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0055445Medicare UPIN