MEDICARE: MRS. VANESSA I DIAZ-PERES CCSS

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	101Y00000X	Counselor		PR

General Provider Information

NPI Number	:	1245433382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA I DIAZ-PERES CCSS

Provider Business Mailing Address
First Line	:	136 CALLE MIGUEL RIVERA TEXIDOR
Second Line	:	URB. ESTANCIAS DEL GOLF
City	:	PONCE
State	:	PR
Zip	:	00730-0501
Country	:	US
Telephone Number	:	787-259-4863
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 CALLE MIGUEL RIVERA TEXIDOR
Second Line	:	URB. ESTANCIAS DEL GOLF
City	:	PONCE
State	:	PR
Zip	:	00730-0501
Country	:	US
Telephone Number	:	787-259-4863
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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