Provider Demographics
NPI:1659426278
Name:DIAZ-CONDE, ROSA ISABEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ISABEL
Last Name:DIAZ-CONDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 GLASGOW
Mailing Address - Street 2:COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4814
Mailing Address - Country:US
Mailing Address - Phone:787-758-8510
Mailing Address - Fax:
Practice Address - Street 1:1814 GLASGOW
Practice Address - Street 2:COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4814
Practice Address - Country:US
Practice Address - Phone:787-758-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD13421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice