Provider Demographics
NPI:1629289251
Name:DIAZ, CARLA M (MS)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.LLANOS DE GURABO
Mailing Address - Street 2:CAMELIA ST. 909
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-384-8111
Mailing Address - Fax:
Practice Address - Street 1:URB.LLANOS DE GURABO
Practice Address - Street 2:CAMELIA ST. 909
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-384-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist