Provider Demographics
NPI:1679839187
Name:DIAZ, CARMEN ENID
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ENID
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C5 CALLE 9
Mailing Address - Street 2:URB DELGADO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3134
Mailing Address - Country:US
Mailing Address - Phone:787-469-8346
Mailing Address - Fax:
Practice Address - Street 1:COND EL PLZ # 5
Practice Address - Street 2:CFSE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1712
Practice Address - Country:US
Practice Address - Phone:787-282-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAF2692183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician