Provider Demographics
NPI:1689786170
Name:DIAZ-ABASCAL, JOSE J (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:DIAZ-ABASCAL
Suffix:
Gender:M
Credentials:DDS
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 870
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0870
Mailing Address - Country:US
Mailing Address - Phone:787-744-3087
Mailing Address - Fax:787-746-4840
Practice Address - Street 1:A 1 MUNOZ RIVERA SUITE 302
Practice Address - Street 2:HIMA SURGICENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0870
Practice Address - Country:US
Practice Address - Phone:787-744-3087
Practice Address - Fax:787-746-4840
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0042126Medicare ID - Type Unspecified
H75254Medicare UPIN