Provider Demographics
NPI:1659428217
Name:LLADO-DIAZ, JOSE RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RICARDO
Last Name:LLADO-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:M4 CALLE CLAVEL
Mailing Address - Street 2:PARQUE DE SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6738
Mailing Address - Country:US
Mailing Address - Phone:787-787-0415
Mailing Address - Fax:
Practice Address - Street 1:K 11.7 CARR. NUM. 2
Practice Address - Street 2:CT RADIOLOGY BLDG.
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7383207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81952Medicare ID - Type Unspecified