Provider Demographics
NPI:1760795702
Name:BERRIOS-DIAZ, YIMAR
Entity Type:Individual
Prefix:DR
First Name:YIMAR
Middle Name:
Last Name:BERRIOS-DIAZ
Suffix:
Gender:F
Credentials:
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 366257
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6257
Mailing Address - Country:US
Mailing Address - Phone:787-250-1708
Mailing Address - Fax:787-758-9200
Practice Address - Street 1:CARR 165 KM 1.2 #48
Practice Address - Street 2:CITY PLAZA SUITE 1010
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-250-1708
Practice Address - Fax:787-758-9200
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257381-1207L00000X
PR18554207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology