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General NPI Number Information
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NPI Number | 1063224384
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Entity Type | Individual
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Provider Name | GINA DIAZ MPSY
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 155 CALLE ANDRES ARUS RIVERA W
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City | GURABO
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State | PR
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Zip | 00778-2321
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Country | US
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Telephone | 939-891-0533
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Fax |
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Provider Business Mailing Address
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Address Line | VILLA GUADALUPE FF14 CALLE 18
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City | CAGUAS
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State | PR
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Zip | 00725-4055
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Country | US
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Telephone | 787-347-7698
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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 | 7343
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License Number State | PR
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