Provider Demographics
NPI:1992079214
Name:DIAZ, ALFREDO CARLO (DC)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:CARLO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79004
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9004
Mailing Address - Country:US
Mailing Address - Phone:787-969-0596
Mailing Address - Fax:
Practice Address - Street 1:LOS ALTOS DEL ESCORIAL 523 BLV DE LA MEDIA LUNA
Practice Address - Street 2:APT. 2305
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-5083
Practice Address - Country:US
Practice Address - Phone:787-969-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor