Provider Demographics
NPI:1861449118
Name:DIAZ, EUSEBIO A (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUSEBIO
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DMD
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 7859
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7859
Mailing Address - Country:US
Mailing Address - Phone:787-381-8635
Mailing Address - Fax:
Practice Address - Street 1:SIERRA DE CAYEY PLAZA SUITE 207
Practice Address - Street 2:AVE. ANTONIO R. BARCELO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-7500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics