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General NPI Number Information
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NPI Number | 1841733623
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Entity Type | Organization
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Legal Business Name | PSICOLOGIA AVANZADA DIAZ
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 613 CALLE HOARE APT 4 COND PLAZA MARTI
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City | SAN JUAN
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State | PR
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Zip | 00907-3681
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Country | US
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Telephone | 787-929-7837
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 493
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City | AGUIRRE
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State | PR
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Zip | 00704-0493
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Country | US
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Telephone | 787-929-7837
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Fax |
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Authorized Official
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Title or Position | PSICOLOGA
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Name | YARITZA PICA DIAZ
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Credential | LIC
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Telephone | 17879297837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3800
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License Number State | PR
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