Provider Demographics
NPI:1821126095
Name:DIAZ-CORREA, JOSE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:DIAZ-CORREA
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:Y9 CALLE 8
Mailing Address - Street 2:URB. MONTECARLO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5267
Mailing Address - Country:US
Mailing Address - Phone:787-257-7477
Mailing Address - Fax:787-756-8814
Practice Address - Street 1:TORRE SAN FRANCISCO SUITE 210
Practice Address - Street 2:369 DE DIEGO ST.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-758-3970
Practice Address - Fax:787-756-8814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-8912DIOtherTRIPLE-S
PR06331-MIOtherCRUZ AZUL
PR27182OtherMCS
PR212265OtherUTI
PR06331-MIOtherCRUZ AZUL
PR2-8912DIOtherTRIPLE-S