Provider Demographics
NPI:1770794307
Name:DIAZ, CARMEN DELIA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DELIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C2 CALLE CAROLA
Mailing Address - Street 2:ROYAL GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-2524
Mailing Address - Country:US
Mailing Address - Phone:787-279-2953
Mailing Address - Fax:
Practice Address - Street 1:AVENUE CENTRAL JUANITA FINAL
Practice Address - Street 2:COMPLEJO CORRECIONAL DE BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958
Practice Address - Country:US
Practice Address - Phone:787-785-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14348208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice