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General NPI Number Information
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NPI Number | 1154037380
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Entity Type | Individual
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Provider Name | ANAIS CORDOVA-DIAZ LPC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | URB. SANS SOUCI B28 CALLE 13
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City | BAYAMON
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State | PR
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Zip | 00957-4336
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Country | US
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Telephone | 787-378-0708
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Fax |
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Provider Business Mailing Address
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Address Line | URB. SANS SOUCI B28 CALLE 13
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City | BAYAMON
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State | PR
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Zip | 00957-4336
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Country | US
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Telephone | 787-378-0708
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002933
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 79653
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License Number State | TX
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