Provider Demographics
NPI:1700920766
Name:DIAZ, ANTONIO M (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:78 CALLE KINGS CT
Mailing Address - Street 2:APT. 7D
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1600
Mailing Address - Country:US
Mailing Address - Phone:787-728-7565
Mailing Address - Fax:787-785-2264
Practice Address - Street 1:B24 CALLE 25
Practice Address - Street 2:FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5548
Practice Address - Country:US
Practice Address - Phone:787-780-9670
Practice Address - Fax:787-785-2264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2014-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR8186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist