Healthcare Provider Details

I. General information

NPI: 1669846366
Provider Name (Legal Business Name): HILDA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H8 CALLE CEIBA QUINTAS DE DORADO
DORADO PR
00646-4714
US

IV. Provider business mailing address

H8 CALLE CEIBA QUINTAS DE DORADO
DORADO PR
00646-4714
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-4977
  • Fax:
Mailing address:
  • Phone: 787-645-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number004108
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number004108
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number004108
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number004108
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number004108
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: