Provider Demographics
NPI:1780822080
Name:CARMEN DIAZ
Entity Type:Organization
Organization Name:CARMEN DIAZ
Other - Org Name:MIRAMAR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-723-2529
Mailing Address - Street 1:PMB 17 UU1 CALLE 39
Mailing Address - Street 2:URB. SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4793
Mailing Address - Country:US
Mailing Address - Phone:787-723-2529
Mailing Address - Fax:787-721-3903
Practice Address - Street 1:AVE. FERNANDEZ JUNCOS #1423
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2696
Practice Address - Country:US
Practice Address - Phone:787-723-2529
Practice Address - Fax:787-721-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6148060001Medicare NSC