Healthcare Provider Details

I. General information

NPI: 1316912348
Provider Name (Legal Business Name): MARIA D RODRIGUEZ DIAZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LA VEGA #24 CALLE PRINCIPAL
VILLALBA PR
00766
US

IV. Provider business mailing address

PO BOX 1088
VILLALBA PR
00766
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-1976
  • Fax: 787-847-1976
Mailing address:
  • Phone: 787-847-1976
  • Fax: 787-847-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number559
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: