Provider Demographics
NPI:1922114370
Name:VILLALOBOS DIAZ, RAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:D
Last Name:VILLALOBOS DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:480 CALLE CESAR GONZALEZ
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2627
Mailing Address - Country:US
Mailing Address - Phone:787-767-8758
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT, SUITE 201 A
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-767-8758
Practice Address - Fax:844-759-2966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3771800Medicaid
PR11041OtherLICENSE