MEDICARE: CARLOS R DIAZ VELEZ MD CSP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009970	OTHER	PR	LICENSE

General Provider Information

NPI Number	:	1821257403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS R DIAZ VELEZ MD CSP

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	:	PRESIDENT
Name	:	DR. CARLOS RUBEN DIAZ
Credential	:	MD
Telephone Number	:	787-721-0525

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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