Provider Demographics
NPI:1174545404
Name:DIAZ-HERNANDEZ, JAIME M (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:M
Last Name:DIAZ-HERNANDEZ
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 1:8 VIA SAN GABRIELE
Mailing Address - Street 2:URB. MONTE ALVERNIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6800
Mailing Address - Country:US
Mailing Address - Phone:787-720-5365
Mailing Address - Fax:
Practice Address - Street 1:CARR. 152 KM. 12 HM. 4
Practice Address - Street 2:SALUD INTEGRAL EN LA MONTANA,INC.
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE20534Medicare UPIN
PR28116Medicare ID - Type Unspecified