Lissette Diaz Olmeda, MD
Individual provider Active NPI General Practice Physician · Arroyo, PR
NPI 1194379750 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1194379750
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 21506 (PR)
- Practice address
- 306 Calle Caribe Urb. Arroyo del Mar
Arroyo, PR 00714-3057 - Phone
- (787) 362-8981
- NPI assigned
- Jul 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| I20230111002812 | PR | Practitioner - General Practice | 8123498946 | Practice locations: Maunabo, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 21506 | PR | Yes |
Addresses
Primary practice location
306 Calle Caribe Urb. Arroyo del Mar
Arroyo, PR 00714-3057
Mailing address
306 Calle Caribe Urb. Arroyo del Mar
Arroyo, PR 00714-3057
Phone (787) 362-8981
Other practice location 1
306 Calle Caribe Urb. Arroyo del Mar
Arroyo, PR 00714-3057
Phone (787) 362-8981
Other providers in Arroyo, PR
- Irna Maysonet Cruz
- Loriann Davila-Santiago
- Russell Davis
- Fermin L De Jesus
- Adelina Diaz Laboy
- Belmarie Diaz Padro
- Odalys Diaz Rodriguez
- Raul E Diaz
- E M a Med Serv CSP
- Kathiushka Del Coral Echandy Torres
All providers in Arroyo, 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 Apr 3, 2020. 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.