Provider Demographics
NPI:1013910231
Name:MARQUES DIAZ, BERNARDO JOSE (MD)
Entity type:Individual
Prefix:
First Name:BERNARDO
Middle Name:JOSE
Last Name:MARQUES DIAZ
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 1:310 LOMAS VERDES AVE. SUITE 208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6638
Mailing Address - Country:US
Mailing Address - Phone:787-751-3150
Mailing Address - Fax:787-767-0338
Practice Address - Street 1:310 LOMAS VERDES AVE. SUITE 208
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6638
Practice Address - Country:US
Practice Address - Phone:787-751-3150
Practice Address - Fax:787-767-0338
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89574Medicare ID - Type Unspecified
PRG89489Medicare UPIN