Provider Demographics
NPI:1962780452
Name:DIAZ NIEVES, IVONNE MARIE
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARIE
Last Name:DIAZ NIEVES
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 1:421 CALLE SAN JOVINO
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-372-1347
Mailing Address - Fax:
Practice Address - Street 1:421 CALLE SAN JOVINO
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4212
Practice Address - Country:US
Practice Address - Phone:787-747-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2163-12355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant