Healthcare Provider Details

I. General information

NPI: 1679767149
Provider Name (Legal Business Name): TANIA DIAZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. MUNOZ RIVERA 500 EL CENTRO II BUILDING SUITES 606 - 607
HATO REY PR
00918
US

IV. Provider business mailing address

TAINO STREET K-21 BRISAS DE MONTECASINO
TOA ALTA PR
00953-3842
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2860
  • Fax: 787-751-5935
Mailing address:
  • Phone: 787-552-0409
  • Fax: 787-251-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number566
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: