Healthcare Provider Details

I. General information

NPI: 1225910854
Provider Name (Legal Business Name): ROXANE RIBOTT DIAZ DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE ACUARELA SUITE A-06
GUAYNABO PR
00969-3577
US

IV. Provider business mailing address

L-48 CALLE 17 RIO GRANDE ESTATES
RIO GRANDE PR
00745-5015
US

V. Phone/Fax

Practice location:
  • Phone: 787-597-9507
  • Fax:
Mailing address:
  • Phone: 787-597-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4673
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: