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General NPI Number Information
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NPI Number | 1285057497
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Entity Type | Individual
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Provider Name | BENJAMIN REYES DIAZ M.PSY
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Gender | Male
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 140 AVE LAS CUMBRES
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City | GUAYNABO
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State | PR
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Zip | 00969-5523
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Country | US
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Telephone | 939-644-3452
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SEC MONTE VERDE
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City | CIDRA
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State | PR
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Zip | 00739-2134
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Country | US
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Telephone | 939-644-3452
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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 | 5147
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License Number State | PR
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