Provider Demographics
NPI:1366448383
Name:DIAZ HERNANDEZ, CARMEN LUZ (OD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LUZ
Last Name:DIAZ HERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 CALLE MADRESELVA
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4879
Mailing Address - Country:US
Mailing Address - Phone:787-263-1335
Mailing Address - Fax:787-263-1335
Practice Address - Street 1:5001 AVE JESUS T PINERO STE 130
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5541
Practice Address - Country:US
Practice Address - Phone:787-263-1335
Practice Address - Fax:787-263-1335
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist