Provider Demographics
NPI:1831309541
Name:DIAZ MORAN, DAMARIS (MD)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:DIAZ MORAN
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:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1513
Mailing Address - Country:US
Mailing Address - Phone:787-587-2216
Mailing Address - Fax:787-998-1996
Practice Address - Street 1:103 AVE. ANTONIO PRINCIPE PLAZA PRADERA EDIF.D SUITE2
Practice Address - Street 2:URB.FRONTERAS DE BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-0000
Practice Address - Country:US
Practice Address - Phone:787-998-1996
Practice Address - Fax:787-998-1996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice