Provider Demographics
NPI:1750425864
Name:DIAZ, CARMEN J (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:J
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 CALLE GARZA
Mailing Address - Street 2:BRISAS DEL PRADO
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-2560
Mailing Address - Country:US
Mailing Address - Phone:787-845-2496
Mailing Address - Fax:
Practice Address - Street 1:19 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3332
Practice Address - Country:US
Practice Address - Phone:787-824-2220
Practice Address - Fax:787-824-5617
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1356483721Medicare UPIN