Provider Demographics
NPI:1578856001
Name:DIAZ MONTES, CARLOS ANTONIO (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANTONIO
Last Name:DIAZ MONTES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 ASHFORD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1494
Mailing Address - Country:US
Mailing Address - Phone:787-725-4313
Mailing Address - Fax:787-725-4914
Practice Address - Street 1:1411 ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1494
Practice Address - Country:US
Practice Address - Phone:787-725-4313
Practice Address - Fax:787-725-4914
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist