Provider Demographics
NPI:1518048800
Name:CARPINTERO DIAZ, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:CARPINTERO DIAZ
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 1:3501 W VINE ST
Mailing Address - Street 2:STE 226
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4633
Mailing Address - Country:US
Mailing Address - Phone:407-530-4802
Mailing Address - Fax:407-530-4910
Practice Address - Street 1:C-1 AVE. AGUSTIN PEREZ ANDINO
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-888-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR068824OtherID NUMBER FOR CRUZ AZUL
PR7450020OtherID NUMBER FOR HUMANA
PR500001EOtherID NUMBER FOR MMM
PR8733OtherID NUMBER FOR IMC
PR28543OtherID NUMBER FOR SSS
PR7195OtherLIC. NUMBER
PR068824OtherID NUMBER FOR CRUZ AZUL
PR0028543Medicare ID - Type Unspecified