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General NPI Number Information
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NPI Number | 1497843965
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Entity Type | Organization
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Legal Business Name | CARMEN DIAZ
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 518 CALLE DRESDE PUERTO NUEVO
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City | SAN JUAN
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State | PR
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Zip | 00920-3731
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Country | US
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Telephone | 787-706-0209
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Fax | 787-774-5991
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Provider Business Mailing Address
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Address Line | 39 STREET URB. SANTA JUANTITA UU 1 PMB 117
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-706-0209
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Fax | 787-774-5991
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARMEN DIAZ
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Credential |
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Telephone | 787-706-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1281640001
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License Number State | PR
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