1427105725 NPI number — MRS. CARMEN DOLORES DIAZ TECH

Table of content: AMELIA R STAHL LAC (NPI 1083396675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427105725 NPI number — MRS. CARMEN DOLORES DIAZ TECH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
CARMEN
Provider Middle Name:
DOLORES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
TECH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ
Provider Other First Name:
CARMEN
Provider Other Middle Name:
DOLORES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
TECH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427105725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4910 CALLE ZUMBADOR
Provider Second Line Business Mailing Address:
CASAMIA
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00728-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-367-0493
Provider Business Mailing Address Fax Number:
787-843-9485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 CALLE ZUMBADOR
Provider Second Line Business Practice Location Address:
CASAMIA
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00728-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-367-0493
Provider Business Practice Location Address Fax Number:
787-843-9485
Provider Enumeration Date:
01/05/2007

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: 247200000X , with the licence number:  2112 , 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)