Healthcare Provider Details

I. General information

NPI: 1265361273
Provider Name (Legal Business Name): ALEXIS HIRAN DIAZ DIAZ LICENCIADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 AVE EMILIO FAGOT
PONCE PR
00716-3615
US

IV. Provider business mailing address

1996 CALLE AFRODITA URB. ALTA VISTA
PONCE PR
00716-2942
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-7691
  • Fax:
Mailing address:
  • Phone: 787-553-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4792
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: