Basic Information
| Provider Information | |||||||||
| NPI: | 1003803693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | MAGDA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 54 | ||||||||
| Address2: | 290 AVE. SANTA ANA TORRIMAR TOWN PARK | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009700054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875044126 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 38 CALLE BETANCES | ||||||||
| Address2: | CLINICA DENTAL AYMAT | ||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006934453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878553996 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 2656 | PR | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.