Provider Demographics
NPI:1629294939
Name:DIAZ, JOSE SIGFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SIGFREDO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CALLE LEALTAD
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-6210
Mailing Address - Country:US
Mailing Address - Phone:787-436-4848
Mailing Address - Fax:
Practice Address - Street 1:118 CALLE LEALTAD
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6210
Practice Address - Country:US
Practice Address - Phone:787-436-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90882084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80932Medicare ID - Type Unspecified