Provider Demographics
NPI:1023052719
Name:DIAZ, CLEMENTE (MD)
Entity type:Individual
Prefix:DR
First Name:CLEMENTE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRIC HOSPITAL DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:PO BOX 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-756-4010
Mailing Address - Fax:787-777-3227
Practice Address - Street 1:UNIVERSITY PEDIATRIC HOSPITAL DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:OFFICE 1A-29 1ST FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-756-4010
Practice Address - Fax:787-777-3227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67231744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder