Provider Demographics
NPI:1891414793
Name:MDD CHILD NEUROLOGY LLC
Entity Type:Organization
Organization Name:MDD CHILD NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-400-8452
Mailing Address - Street 1:URB LAS COLINAS
Mailing Address - Street 2:M-4 COLINAS BUENA VISTA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-400-8452
Mailing Address - Fax:
Practice Address - Street 1:1845 BAYAMON MEDICAL PLAZA CARR 2
Practice Address - Street 2:SUITE 910
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-400-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty