=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902050958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLEEN DIAZ S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2008
-----------------------------------------------------
Last Update Date | 11/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 CALLE JOSE I QUINTON
-----------------------------------------------------
City | COAMO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00769-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-471-0008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE SERRACANTES A-3 URB. MONTE REAL
-----------------------------------------------------
City | COAMO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-825-3806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9294
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------