Provider Demographics
NPI:1629058482
Name:DIAZ - RODRIGUEZ, RUBEN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:DIAZ - RODRIGUEZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:STREET FIDALGO DIAZ
Mailing Address - Street 2:CALDAS #2037
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5442
Mailing Address - Country:US
Mailing Address - Phone:787-798-0750
Mailing Address - Fax:787-787-7523
Practice Address - Street 1:BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 611
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-0750
Practice Address - Fax:787-787-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2011-04-05
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Provider Licenses
StateLicense IDTaxonomies
PR61922080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97625Medicare PIN