Healthcare Provider Details

I. General information

NPI: 1407750474
Provider Name (Legal Business Name): MARIELA DIAZ ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 AVE AGUSTIN RAMOS CALERO
ISABELA PR
00662
US

IV. Provider business mailing address

PO BOX 3695
AGUADILLA PR
00605-3695
US

V. Phone/Fax

Practice location:
  • Phone: 939-633-0141
  • Fax:
Mailing address:
  • Phone: 939-208-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1258
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: