Provider Demographics
NPI:1043293251
Name:DIAZ, CAREM ROSA (DMD)
Entity type:Individual
Prefix:DR
First Name:CAREM
Middle Name:ROSA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 10TH ST ANDREA'S COURT
Mailing Address - Street 2:APT 145
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-7821
Mailing Address - Country:US
Mailing Address - Phone:787-761-7154
Mailing Address - Fax:
Practice Address - Street 1:#51 SAN JOSE AVE.
Practice Address - Street 2:LITTLE PLAZA BLDG., SUITE #203
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD-24431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry