Provider Demographics
NPI:1033992144
Name:DIAZ LOPEZ, GIOVANNIE MIGUEL (CRNA)
Entity type:Individual
Prefix:
First Name:GIOVANNIE
Middle Name:MIGUEL
Last Name:DIAZ LOPEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AVE LA SIERRA APT 37
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4337
Mailing Address - Country:US
Mailing Address - Phone:787-902-4591
Mailing Address - Fax:
Practice Address - Street 1:URB LA SIERRA DEL RIO C/3-D8
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-902-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9632260163W00000X
PR073619163W00000X
FL11027017367500000X
PR003690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse