Individual provider Active NPI

Iliana Alvarado-Diaz, O.D.

  • Optometrist
  • Humacao, PR
National Provider Identifier
1972834547
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
674 Issued in PR
Practice address
250 Calle Cruz Ortiz Stella Ste 11
Humacao, PR 00791-4144
Phone
(939) 428-1140
Fax
(877) 496-5503
NPI assigned
Jan 21, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 674 PR Primary

Addresses

Primary practice location

250 Calle Cruz Ortiz Stella Ste 11
Humacao, PR 00791-4144

Mailing address

250 Calle Cruz Ortiz Stella Ste 11
Humacao, PR 00791-4144
Phone (787) 367-6238

Other practice location 1

615 Carr 152 Ste 3
Naranjito, PR 00719-3809
Phone (939) 319-7007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120104000086 PR Practitioner - Optometry 2466628086 Practice locations: Humacao, PR; Naranjito, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
674PRMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1972834547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CALLE CRUZ ORTIZ STELLA STE 11",
            "city": "HUMACAO",
            "state": "PR",
            "postal_code": "007914144",
            "telephone_number": "787-367-6238",
            "fax_number": "877-496-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CALLE CRUZ ORTIZ STELLA STE 11",
            "city": "HUMACAO",
            "state": "PR",
            "postal_code": "007914144",
            "telephone_number": "939-428-1140",
            "fax_number": "877-496-5503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Carr 152 Ste 3",
            "address_purpose": "LOCATION",
            "city": "Naranjito",
            "state": "PR",
            "postal_code": "007193809",
            "country_code": "US",
            "telephone_number": "939-319-7007",
            "fax_number": "877-496-5503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALVARADO-DIAZ",
        "first_name": "ILIANA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Humacao, PR

Sources for this page

Verify at the official NPI Registry.