MEDICARE: DR. CARLOS RUBEN DIAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	009970	PR

General Provider Information

NPI Number	:	1093701062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS RUBEN DIAZ MD

Provider Business Mailing Address
First Line	:	1449 CALLE AMERICO SALAS
Second Line	:	EDIFICIO PAVIA II, SUITE 102
City	:	SANTURCE
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-721-0525
Fax Number	:	787-722-1225

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS
Second Line	:	EDIFICIO PAVIA II, SUITE 102
City	:	SANTURCE
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-721-0525
Fax Number	:	787-722-1225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/01/2014

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