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General NPI Number Information
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NPI Number | 1265361273
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Entity Type | Individual
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Provider Name | ALEXIS HIRAN DIAZ DIAZ LICENCIADO
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Gender | Male
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Dates
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Enumeration Date | 05/15/2026
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Last Update Date | 05/15/2026
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Provider Practice Location Address
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Address Line | 2972 AVE EMILIO FAGOT
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City | PONCE
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State | PR
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Zip | 00716-3615
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Country | US
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Telephone | 787-651-7691
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Fax |
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Provider Business Mailing Address
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Address Line | 1996 CALLE AFRODITA URB. ALTA VISTA
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City | PONCE
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State | PR
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Zip | 00716-2942
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Country | US
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Telephone | 787-553-1654
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4792
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License Number State | PR
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