Healthcare Provider Details

I. General information

NPI: 1902461924
Provider Name (Legal Business Name): KAREN DIAZ MIRANDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSO OF PUERTO RICO 350 AVE CHARDON SUITE 500 TORRE CHARDON
SAN JUAN PR
00918-2137
US

IV. Provider business mailing address

26 MUNOZ RIVERA BETANIA
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-3000
  • Fax:
Mailing address:
  • Phone: 787-590-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number87374G
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: