Provider Demographics
NPI:1225163785
Name:PEREZ-DIAZ, CARMEN MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MARIA
Last Name:PEREZ-DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CALLE LIMONCILLO
Mailing Address - Street 2:EXT. SANTA MARIA,
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6622
Mailing Address - Country:US
Mailing Address - Phone:787-759-8793
Mailing Address - Fax:
Practice Address - Street 1:AMERICO MIRANDA AVE P R MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-759-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR66322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80026Medicare ID - Type Unspecified