Provider Demographics
NPI:1912362146
Name:CARTAGENA DIAZ, CARLOS ENRIQUE
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:CARTAGENA DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 15163
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-8339
Mailing Address - Country:US
Mailing Address - Phone:787-453-8577
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 15163
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-8339
Practice Address - Country:US
Practice Address - Phone:787-453-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health