Provider Demographics
NPI:1578591772
Name:LOPEZ DIAZ, NYDIA M (MD)
Entity type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:M
Last Name:LOPEZ DIAZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1130 CALLE ITALIA
Mailing Address - Street 2:PLAZA DE LAS FUENTES
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3801
Mailing Address - Country:US
Mailing Address - Phone:787-279-3297
Mailing Address - Fax:787-296-4671
Practice Address - Street 1:CARR. 828 KM. 0.1
Practice Address - Street 2:BARRIO PINAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4611
Practice Address - Country:US
Practice Address - Phone:787-279-3297
Practice Address - Fax:787-279-3297
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-08-14
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Provider Licenses
StateLicense IDTaxonomies
PR11254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83621Medicare PIN
PRG-03019Medicare UPIN