Healthcare Provider Details

I. General information

NPI: 1811491350
Provider Name (Legal Business Name): CAROLINA SOFIA DIAZ-LOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CALLE AMERICO SALAS STE 401
SAN JUAN PR
00909-2178
US

IV. Provider business mailing address

PO BOX 19647
SAN JUAN PR
00910-1647
US

V. Phone/Fax

Practice location:
  • Phone: 787-919-7865
  • Fax:
Mailing address:
  • Phone: 787-919-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number022249
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022249
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: