Provider Demographics
NPI:1740414291
Name:DE LA PAZ, MARYKNOLL (MD)
Entity Type:Individual
Prefix:
First Name:MARYKNOLL
Middle Name:
Last Name:DE LA PAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYNOLL
Other - Middle Name:
Other - Last Name:DE LA PAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 CALLE FRESA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5106
Mailing Address - Country:US
Mailing Address - Phone:787-549-6651
Mailing Address - Fax:
Practice Address - Street 1:2225 PONCE BYP STE 607
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1379
Practice Address - Country:US
Practice Address - Phone:787-284-4830
Practice Address - Fax:787-284-4814
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20224207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology