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General NPI Number Information
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NPI Number | 1003465295
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Entity Type | Individual
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Provider Name | MARIEL ADORNO DIAZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | CARR 10 R 651 KM 2.4 SEC EL JUNCO, BO. JUNCOS
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City | ARECIBO
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State | PR
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Zip | 00612-0000
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Country | US
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Telephone | 787-214-9887
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1608
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City | ARECIBO
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State | PR
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Zip | 00613-1608
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Country | US
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Telephone | 787-956-0062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6013
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License Number State | PR
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