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General NPI Number Information
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NPI Number | 1821983404
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Entity Type | Individual
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Provider Name | CANDY DIAZ AVALO
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Gender | Female
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 627 WARWICK AVE
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City | WARWICK
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State | RI
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Zip | 02888-2678
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Country | US
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Telephone | 401-226-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 289 WASHINGTON AVE
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City | PROVIDENCE
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State | RI
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Zip | 02905-2839
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Country | US
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Telephone | 401-226-4846
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | RI
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