MEDICARE: JANIS J DIAZ PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4104	PR
2	101YP1600X	Pastoral Counselor
3	103G00000X	Clinical Neuropsychologist	4104	PR
4	103TA0400X	Addiction (Substance Use Disorder) Psychologist	4104	PR
5	103TA0700X	Adult Development & Aging Psychologist	4104	PR
6	103TB0200X	Cognitive & Behavioral Psychologist	4104	PR
7	103TC2200X	Clinical Child & Adolescent Psychologist	4104	PR
8	103TF0000X	Family Psychologist	4104	PR
9	103TF0200X	Forensic Psychologist	4104
10	103TH0100X	Health Service Psychologist	4104
11	103TM1800X	Intellectual & Developmental Disabilities Psychologist	4104	PR
12	103TP0814X	Psychoanalysis Psychologist	4104
13	103TP2701X	Group Psychotherapy Psychologist	4104
14	103TR0400X	Rehabilitation Psychologist	4104

General Provider Information

NPI Number	:	1366712226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS J DIAZ PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 414
Second Line	:
City	:	AGUIRRE
State	:	PR
Zip	:	00704-0414
Country	:	US
Telephone Number	:	787-677-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 CALLE GUAYAMA
Second Line	:
City	:	SALINAS
State	:	PR
Zip	:	00751-3314
Country	:	US
Telephone Number	:	787-677-7704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	02/14/2012

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