Provider Demographics
NPI:1609869338
Name:DIAZ, JANET (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AMAURY VERAY A-20
Mailing Address - Street 2:URB. BUENA VISTA
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3519
Mailing Address - Country:US
Mailing Address - Phone:787-267-1269
Mailing Address - Fax:787-267-1269
Practice Address - Street 1:CARR 368 KM 12.6
Practice Address - Street 2:BO. SUSUA BAJA
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-267-1269
Practice Address - Fax:787-267-1269
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDRAJANET1OtherINMEDIATA
JD1269OtherINMEDIATA
PRSESPROOtherTRIPLE S