Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D-2443 | PR |
NPI | 1043293251 |
---|---|
Provider Name | Dr. Carem Rosa Diaz |
First Address | Trujillo Alto, PR 00976-7821 |
Second Address | Aibonito, PR 00705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 11/04/2013 |