Provider Demographics
NPI:1821257403
Name:CARLOS R DIAZ VELEZ MD CSP
Entity Type:Organization
Organization Name:CARLOS R DIAZ VELEZ MD CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-0525
Mailing Address - Street 1:1449 CALLE AMERICO SALAS
Mailing Address - Street 2:EDIFICIO PAVIA II SUITE 102
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2100
Mailing Address - Country:US
Mailing Address - Phone:787-721-0525
Mailing Address - Fax:787-722-1225
Practice Address - Street 1:1449 CALLE AMERICO SALAS
Practice Address - Street 2:EDIFICIO PAVIA II SUITE 102
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2100
Practice Address - Country:US
Practice Address - Phone:787-721-0525
Practice Address - Fax:787-722-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009970207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR009970OtherLICENSE
PRF54655Medicare UPIN