Provider Demographics
NPI:1447149265
Name:GONZALEZ DIAZ, JUAN JAVIER
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JAVIER
Last Name:GONZALEZ DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CALLE GOLONDRINA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9413
Mailing Address - Country:US
Mailing Address - Phone:787-951-8025
Mailing Address - Fax:
Practice Address - Street 1:1395 CALLE SAN RAFAEL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2518
Practice Address - Country:US
Practice Address - Phone:787-999-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17483I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice