Provider Demographics
NPI:1083790737
Name:RODRIGUEZ - DIAZ, MARIA DEL CARMEN
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:RODRIGUEZ - DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 24647
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9647
Mailing Address - Country:US
Mailing Address - Phone:787-891-9797
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANDRES MENDEZ LICIAGA #13
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR480291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory