Provider Demographics
NPI:1427105725
Name:DIAZ, CARMEN DOLORES (TECH)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:DOLORES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:DOLORES
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TECH
Mailing Address - Street 1:4910 CALLE ZUMBADOR
Mailing Address - Street 2:CASAMIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3413
Mailing Address - Country:US
Mailing Address - Phone:787-367-0493
Mailing Address - Fax:787-843-9485
Practice Address - Street 1:4910 CALLE ZUMBADOR
Practice Address - Street 2:CASAMIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3413
Practice Address - Country:US
Practice Address - Phone:787-367-0493
Practice Address - Fax:787-843-9485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2112247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other