=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679767149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANIA DIAZ MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 08/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. MUNOZ RIVERA 500 EL CENTRO II BUILDING SUITES 606 - 607
-----------------------------------------------------
City | HATO REY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-2860
-----------------------------------------------------
Fax | 787-751-5935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | TAINO STREET K-21 BRISAS DE MONTECASINO
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-552-0409
-----------------------------------------------------
Fax | 787-251-8573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 566
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------