MEDICARE: MRS. REBECA DIAZ PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3749	PR

General Provider Information

NPI Number	:	1235449620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECA DIAZ PH.D

Provider Business Mailing Address
First Line	:	100 CALLE MARACAIBO
Second Line	:	PARK GARDENS COURT 105
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2234
Country	:	US
Telephone Number	:	787-340-4654
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CALLE MARACAIBO
Second Line	:	PARK GARDENS COURT 105
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2234
Country	:	US
Telephone Number	:	787-340-7642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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