Provider Demographics
NPI:1003117102
Name:DIAZ, CARMEN LOURDES (RN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LOURDES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 10861
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9677
Mailing Address - Country:US
Mailing Address - Phone:787-516-8175
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 10861
Practice Address - Street 2:SABANA WARD
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-9677
Practice Address - Country:US
Practice Address - Phone:787-516-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2020-08-07
Deactivation Date:2020-05-21
Deactivation Code:
Reactivation Date:2020-08-05
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
PR14673163WC2100X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care