Provider Demographics
NPI:1720092323
Name:DIAZ VAZQUEZ, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:DIAZ VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE SAN CRUZ NUM 66
Mailing Address - Street 2:INTS SAN PABLO OFIC 202
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-798-6550
Mailing Address - Fax:787-798-6590
Practice Address - Street 1:CALLE SAN CRUZ NUM 66
Practice Address - Street 2:INTS SAN PABLO OFIC 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-6550
Practice Address - Fax:787-798-6590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6867207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD32959Medicare UPIN
PR29155AMedicare PIN