Provider Demographics
NPI:1831108653
Name:PEREIRA DIAZ, FELIX (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:
Last Name:PEREIRA DIAZ
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:CARR. 181 ENTRADA BARRIO LA GLORIA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1109
Mailing Address - Country:US
Mailing Address - Phone:787-760-4890
Mailing Address - Fax:787-760-4890
Practice Address - Street 1:CARR. 181 ENTRADA BARRIO LA GLORIA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977-1109
Practice Address - Country:US
Practice Address - Phone:787-760-4890
Practice Address - Fax:787-760-4890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice