Omar E Diaz Sojo, M.D. – General Practice Physician

Key facts

NPI: 1104802065
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Physician 208D00000X
License: 16148 (PR)
Practice address: PQ28 Ave El Comandante
Carolina, PR 00982-2777
Phone: (787) 769-6548
Fax: (787) 769-6565
NPI assigned: Dec 21, 2005
Sex: Male
Sole proprietor: Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Centro de Especialistas Cuidad del Yunque Primary Care Clinic/Center · Rio Grande, PR · NPI 1063639755

NPD (past)
El Medico Visitante...,P.S.C. Health Maintenance Organization · San Juan, PR · NPI 1992855746

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PR
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20060111000525	PR	Practitioner - General Practice	8022031442	Practice locations: Rio Grande, PR

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
16148	PR	MD	Pharmacy Technician

Practice roles

Organization	Specialty	Status	New patients
Centro de Especialistas Cuidad del Yunque		Past	Accepting new patients
El Medico Visitante...,P.S.C.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Physician	208D00000X	16148	PR	Yes

Addresses

Primary practice location

PQ28 Ave El Comandante
Carolina, PR 00982-2777

Mailing address

369 Calle Citadel
Reparto Universitario
San Juan, PR 00926-1824
Phone (787) 613-2525

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 28, 2010.

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293494400000",
    "number": "1104802065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 CALLE CITADEL",
            "address_2": "REPARTO UNIVERSITARIO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009261824",
            "telephone_number": "787-613-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PQ28 AVE EL COMANDANTE",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009822777",
            "telephone_number": "787-769-6548",
            "fax_number": "787-769-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ SOJO",
        "first_name": "OMAR",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2010-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "16148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carolina, PR

All providers in Carolina, PR · General Practice Physician in Puerto Rico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.