Provider Demographics
NPI:1619976487
Name:DE PENA DIAZ, TULIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TULIA
Middle Name:
Last Name:DE PENA DIAZ
Suffix:
Gender:F
Credentials:DDS
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 1300
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1300
Mailing Address - Country:US
Mailing Address - Phone:787-864-1590
Mailing Address - Fax:787-864-4364
Practice Address - Street 1:ASHFORD ST. 82 NORTE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-1590
Practice Address - Fax:787-864-4364
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice