Provider Demographics
NPI:1891850426
Name:PABLOS, DIEGO E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:E
Last Name:PABLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DIEGO
Other - Middle Name:
Other - Last Name:PABLOS-DUCLERC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:509 VILLA FONTANA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7452
Mailing Address - Country:US
Mailing Address - Phone:787-833-0420
Mailing Address - Fax:787-833-0420
Practice Address - Street 1:55 CALLE DR BASORA N # OF102
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-833-0420
Practice Address - Fax:787-833-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5352207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038557900Medicaid