Provider Demographics
NPI:1427242791
Name:DIAZ, PRISCILLA
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CONSTANCIA
Mailing Address - Street 2:3161 AVE. JULIO E. MONAGAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2205
Mailing Address - Country:US
Mailing Address - Phone:787-842-6646
Mailing Address - Fax:787-840-7761
Practice Address - Street 1:BARRIO MACHUELO
Practice Address - Street 2:CARRETERA 14
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-842-6646
Practice Address - Fax:787-840-7761
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator