Provider Demographics
NPI:1841485174
Name:DIAZ, SANDRA M (ATO)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ATO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA ROSA
Mailing Address - Street 2:CALLE MAUREEN
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-602-7749
Mailing Address - Fax:
Practice Address - Street 1:HOSP.PEDIATRICO UNIVERSITARIO, CENTRO PEDIATRICO METRO
Practice Address - Street 2:CALL BOX 191079
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist