Provider Demographics
NPI:1952391336
Name:GONZALEZ DIAZ, JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:GONZALEZ DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CALLE SIERRA MORENA
Mailing Address - Street 2:PMB #330
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5539
Mailing Address - Country:US
Mailing Address - Phone:787-886-5506
Mailing Address - Fax:787-876-4116
Practice Address - Street 1:LOCAL AA 5 LOIZA VALLEY SHOPPING CENTER
Practice Address - Street 2:LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-886-5506
Practice Address - Fax:787-876-4116
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07130207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67184Medicare UPIN
98688Medicare ID - Type Unspecified