Healthcare Provider Details

I. General information

NPI: 1003117102
Provider Name (Legal Business Name): CARMEN LOURDES DIAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date: 05/21/2020
Reactivation Date: 08/05/2020

III. Provider practice location address

RR 1 BOX 10861 SABANA WARD
OROCOVIS PR
00720-9677
US

IV. Provider business mailing address

RR 1 BOX 10861
OROCOVIS PR
00720-9677
US

V. Phone/Fax

Practice location:
  • Phone: 787-516-8175
  • Fax:
Mailing address:
  • Phone: 787-516-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: