Provider Demographics
NPI:1952571598
Name:DIAZ PINEIRO, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:DIAZ PINEIRO
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:PO BOX 22321
Mailing Address - Street 2:UPR STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-2321
Mailing Address - Country:US
Mailing Address - Phone:787-758-0120
Mailing Address - Fax:787-250-8123
Practice Address - Street 1:AVE J T PINERO 265 HYDE PARK
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-758-0120
Practice Address - Fax:787-250-5123
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR455246QM0706X
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38114Medicare PIN