Provider Demographics
NPI:1619455623
Name:DIAZ RUBAYO, DAVID ALEJANDRO (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEJANDRO
Last Name:DIAZ RUBAYO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 AVE PONCE DE LEON STE 713
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5030
Mailing Address - Country:US
Mailing Address - Phone:787-765-8394
Mailing Address - Fax:
Practice Address - Street 1:CALLE REINA ISABEL G10
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-646-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32801223P0700X
NY059799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics