Provider Demographics
NPI:1720624349
Name:ROSARIO DIAZ, VANITY PRISCILLA (MD)
Entity Type:Individual
Prefix:
First Name:VANITY
Middle Name:PRISCILLA
Last Name:ROSARIO DIAZ
Suffix:
Gender:F
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:HC 4 BOX 17537
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9501
Mailing Address - Country:US
Mailing Address - Phone:939-405-8735
Mailing Address - Fax:
Practice Address - Street 1:2435 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2112
Practice Address - Country:US
Practice Address - Phone:939-405-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice