MEDICARE: MRS. CARMEN ENID DIAZ

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	183700000X	Pharmacy Technician	AF2692	PR

General Provider Information

NPI Number	:	1679839187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN ENID DIAZ

Provider Business Mailing Address
First Line	:	C5 CALLE 9
Second Line	:	URB DELGADO
City	:	CAGUAS
State	:	PR
Zip	:	00725-3134
Country	:	US
Telephone Number	:	787-469-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND EL PLZ # 5
Second Line	:	CFSE
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1712
Country	:	US
Telephone Number	:	787-282-7400
Fax Number	:

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

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/09/2012

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