Provider Demographics
NPI:1619514189
Name:KUTCHER DIAZ, ROBERTO D
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:D
Last Name:KUTCHER DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ASHFORD AVE COND. ASHFORD 1000
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-466-7067
Mailing Address - Fax:
Practice Address - Street 1:ASHFORD AVE COND. ASHFORD 1000 APT 4
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-0090
Practice Address - Country:US
Practice Address - Phone:787-466-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program