Provider Demographics
NPI:1093701062
Name:DIAZ, CARLOS RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RUBEN
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1449 CALLE AMERICO SALAS
Mailing Address - Street 2:EDIFICIO PAVIA II, SUITE 102
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2100
Mailing Address - Country:US
Mailing Address - Phone:787-721-0525
Mailing Address - Fax:787-722-1225
Practice Address - Street 1:1449 CALLE AMERICO SALAS
Practice Address - Street 2:EDIFICIO PAVIA II, SUITE 102
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2100
Practice Address - Country:US
Practice Address - Phone:787-721-0525
Practice Address - Fax:787-722-1225
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR009970207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83306Medicare ID - Type Unspecified
PRF54655Medicare UPIN