Provider Demographics
NPI:1770329955
Name:DIAZ MARMOLEJOS, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:DIAZ MARMOLEJOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CALLE GUAYAMA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4426
Mailing Address - Country:US
Mailing Address - Phone:939-599-5904
Mailing Address - Fax:
Practice Address - Street 1:61 CALLE GUAYAMA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4426
Practice Address - Country:US
Practice Address - Phone:939-599-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist