Provider Demographics
NPI:1811107212
Name:DIAZ MARTINEZ, PEDRO JUAN (MD)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JUAN
Last Name:DIAZ MARTINEZ
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:RR 5 BOX 8992
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9237
Mailing Address - Country:US
Mailing Address - Phone:787-870-2367
Mailing Address - Fax:787-870-2367
Practice Address - Street 1:87 STREET JOSE' DEDIEGO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2415
Practice Address - Country:US
Practice Address - Phone:787-870-2367
Practice Address - Fax:787-870-2367
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice