=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326995333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAZ MEDERO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB LA RAMBLA 914 CALLE ZARAGOZA
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-588-1806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EST DE MONTE RIO 21 CALLE HELICONIA
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00736-9678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | LUIS DIAZ MEDERO
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 787-975-3272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------