Healthcare Provider Details

I. General information

NPI: 1780822080
Provider Name (Legal Business Name): CARMEN DIAZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. FERNANDEZ JUNCOS #1423
SANTURCE PR
00909-2696
US

IV. Provider business mailing address

PMB 17 UU1 CALLE 39 URB. SANTA JUANITA
BAYAMON PR
00956-4793
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-2529
  • Fax: 787-721-3909
Mailing address:
  • Phone: 787-723-2529
  • Fax: 787-721-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CARMEN DIAZ
Title or Position: OWNER
Credential:
Phone: 787-723-2529