Provider Demographics
NPI:1700879483
Name:DIAZ FERNANDEZ, JOVINO (OD)
Entity Type:Individual
Prefix:DR
First Name:JOVINO
Middle Name:
Last Name:DIAZ FERNANDEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET A EXTENSION JARDINES DE HUMACAO
Mailing Address - Street 2:BB13
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-0000
Mailing Address - Country:US
Mailing Address - Phone:787-627-1724
Mailing Address - Fax:
Practice Address - Street 1:BB13 EXT JARD DE HUMACAO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3724
Practice Address - Country:US
Practice Address - Phone:787-627-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist