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General NPI Number Information
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NPI Number | 1861251647
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Entity Type | Individual
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Provider Name | TAMARA YALI MORI DIAZ
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Gender | Female
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 906 CALLE DR VIRGILIO BIAGGI URB VILLA GRILLASCA
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City | PONCE
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State | PR
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Zip | 00717-1108
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Country | US
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Telephone | 787-840-7928
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Fax |
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Provider Business Mailing Address
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Address Line | E1 CALLE 5
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City | YAUCO
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State | PR
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Zip | 00698-4308
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Country | US
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Telephone | 939-525-0225
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1391
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License Number State | PR
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