Provider Demographics
NPI:1760693626
Name:DIAZ, JOSEFINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVE PINERO
Mailing Address - Street 2:CONDOMINIO PARQUE. DE LOYOLA TN, APT. 505
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 AVE PINERO
Practice Address - Street 2:CONDOMINIO PARQUE. DE LOYOLA TN, APT. 505
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4058
Practice Address - Country:US
Practice Address - Phone:787-993-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5603251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management