Healthcare Provider Details

I. General information

NPI: 1326288200
Provider Name (Legal Business Name): ANESKA ROSARIO DIAZ SR. PSICOLOGIST CLINICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANESKA ROSARIO DIAZ SR. PSICOLOGIST CLINICO

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ONEILL CALLE B #12
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 3097
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-462-8737
  • Fax:
Mailing address:
  • Phone: 787-462-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3299
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: