1043293251 NPI number — DR. CAREM ROSA DIAZ D.M.D.

Table of content: DR. CAREM ROSA DIAZ D.M.D. (NPI 1043293251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043293251 NPI number — DR. CAREM ROSA DIAZ D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
CAREM
Provider Middle Name:
ROSA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043293251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 10TH ST ANDREA'S COURT
Provider Second Line Business Mailing Address:
APT 145
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-7821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-7154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#51 SAN JOSE AVE.
Provider Second Line Business Practice Location Address:
LITTLE PLAZA BLDG., SUITE #203
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-0575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  D-2443 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)