Provider Demographics
NPI:1750483731
Name:HERRERA, WILLIAM DIAZ (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DIAZ
Last Name:HERRERA
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 7891
Mailing Address - Street 2:PMB 639
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:939-630-9574
Mailing Address - Fax:787-782-3870
Practice Address - Street 1:AVE SAO PATRICAS
Practice Address - Street 2:#765 CAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-782-3870
Practice Address - Fax:787-782-3870
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics