Provider Demographics
NPI:1295147403
Name:DIAZ CORREA, JAIME J (DMD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:J
Last Name:DIAZ CORREA
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 373068
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00737
Mailing Address - Country:UM
Mailing Address - Phone:787-312-5027
Mailing Address - Fax:
Practice Address - Street 1:58 CALLE BARBOSA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4727
Practice Address - Country:US
Practice Address - Phone:787-263-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice