Provider Demographics
NPI:1164726667
Name:DIAZ BARCELO, CARLOS S (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:S
Last Name:DIAZ BARCELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:1130 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1457
Practice Address - Country:US
Practice Address - Phone:407-382-1376
Practice Address - Fax:321-235-3232
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18116208D00000X
FLACN808208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN808OtherMEDICAL KICENSE
FLACN808OtherMEDICAL KICENSE