Provider Demographics
NPI:1396868097
Name:DIAZ, JAIME IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:IVAN
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:HC-01
Mailing Address - Street 2:BOX 6527
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-3567
Mailing Address - Fax:787-735-3567
Practice Address - Street 1:138 AVENIDA WINSTON CHURCILL
Practice Address - Street 2:PMB 854 URB CROWN HILLS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-0613
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:787-759-0101
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR14782207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI25740Medicare UPIN
PRI25740Medicare UPIN