Provider Demographics
NPI:1679661201
Name:JORDAN DIAZ, GUILLERMO H (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:H
Last Name:JORDAN 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:PO BOX 10975
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0975
Mailing Address - Country:US
Mailing Address - Phone:787-780-6223
Mailing Address - Fax:787-269-1015
Practice Address - Street 1:TORRE SAN PABLO
Practice Address - Street 2:SUITE 102-B CALLE SANTA CRUZ #68
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-6223
Practice Address - Fax:787-269-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4346207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-08310Medicare UPIN