Provider Demographics
NPI:1629159645
Name:DIAZ BARRIOS, LUIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:DIAZ BARRIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30035
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-1035
Mailing Address - Country:US
Mailing Address - Phone:787-860-0005
Mailing Address - Fax:787-860-0676
Practice Address - Street 1:AVE. GENERAL VALERO #303
Practice Address - Street 2:SUITE 102
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-0005
Practice Address - Fax:787-860-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28913DIMedicare ID - Type UnspecifiedPROVIDER NUMBER
PRC79795Medicare UPIN