Provider Demographics
NPI:1669459426
Name:DIAZ SOLA, GISELA M (DC)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:M
Last Name:DIAZ SOLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA SAN MIGUEL SUITE 208
Mailing Address - Street 2:EXPRESO MANUEL RIVERA MORALES
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-748-8585
Mailing Address - Fax:787-748-8787
Practice Address - Street 1:GALERIA PACIFICO SUITE 106
Practice Address - Street 2:AVE LAS CUMBRES INT CARR 844
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0092
Practice Address - Country:US
Practice Address - Phone:787-748-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98923Medicare UPIN
PR0068176Medicare ID - Type Unspecified