Healthcare Provider Details

I. General information

NPI: 1033294442
Provider Name (Legal Business Name): LUIS A DIAZ ROSADO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AA1 CALLE 24
TOA ALTA PR
00953-4325
US

IV. Provider business mailing address

1635 CALLE CRESTONE
TOA ALTA PR
00953-5250
US

V. Phone/Fax

Practice location:
  • Phone: 787-800-9294
  • Fax:
Mailing address:
  • Phone: 787-800-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2174
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: