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General NPI Number Information
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NPI Number | 1447453246
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Entity Type | Individual
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Provider Name | MARICELLI DIAZ MA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | AVE. LAS CUEVAS CARR .199 INTER. 845
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City | TRUJILLO ALTO
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-627-0426
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Fax |
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Provider Business Mailing Address
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Address Line | URB. ROLLING HILL FILADELFIA 234
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-627-0426
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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 | 1711
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License Number State | PR
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