Healthcare Provider Details

I. General information

NPI: 1073431128
Provider Name (Legal Business Name): AMARILIS DIAZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CIUDAD JARDIN SHOOPING CENTER ESQ. PR #199, AV. LOS DOMINICOS
BAYAMON PR
00957
US

IV. Provider business mailing address

HC 3 BOX 7608
COMERIO PR
00782-9515
US

V. Phone/Fax

Practice location:
  • Phone: 787-222-9616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007143
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: