Provider Demographics
NPI:1316912348
Name:RODRIGUEZ DIAZ, MARIA D (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-847-1976
Mailing Address - Fax:787-847-1976
Practice Address - Street 1:URB LA VEGA #24 CALLE PRINCIPAL
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-1976
Practice Address - Fax:787-847-1976
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87122Medicare ID - Type Unspecified