Most Relevant Information
Provider Data
| NPI Number: | 1003378829 |
| Provider Name: | KELVIN DIAZ PEREZ |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/01/2019 |
| Last Updated: | 06/02/2020 |
Provider Practice Location
80 SEYMOUR ST
HARTFORD
CT
061063315
Practice Location Phone/Fax
| Phone: | 8605455000 |
| Fax: |
Provider Mailing Location
HC 57 BOX 15599
AGUADA
PR
006029832
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |