Provider Demographics
NPI:1528067055
Name:DIAZ, HECTOR ENRIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:ENRIQUE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P60 AVE SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4954
Mailing Address - Country:US
Mailing Address - Phone:787-779-3333
Mailing Address - Fax:787-779-3300
Practice Address - Street 1:P60 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4954
Practice Address - Country:US
Practice Address - Phone:787-779-3333
Practice Address - Fax:787-779-3300
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA903OtherIMC
PR57389OtherTRIPLE S