Healthcare Provider Details

I. General information

NPI: 1093701062
Provider Name (Legal Business Name): CARLOS RUBEN DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 CALLE AMERICO SALAS EDIFICIO PAVIA II, SUITE 102
SANTURCE PR
00909-2100
US

IV. Provider business mailing address

1449 CALLE AMERICO SALAS EDIFICIO PAVIA II, SUITE 102
SANTURCE PR
00909-2100
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-0525
  • Fax: 787-722-1225
Mailing address:
  • Phone: 787-721-0525
  • Fax: 787-722-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number009970
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: