Healthcare Provider Details

I. General information

NPI: 1225570831
Provider Name (Legal Business Name): DRA RAMONA DE LOURDES DIAZ JIMENEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 SANTANA
ARECIBO PR
00612-6708
US

IV. Provider business mailing address

513 SANTANA
ARECIBO PR
00612-6708
US

V. Phone/Fax

Practice location:
  • Phone: 787-356-5376
  • Fax: 787-881-4507
Mailing address:
  • Phone: 787-356-5376
  • Fax: 787-881-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number5660
License Number StatePR

VIII. Authorized Official

Name: DR. RAMONA DE LOURDES DIAZ JIMENEZ
Title or Position: OWNER
Credential: M.D
Phone: 787-356-5376