Provider Demographics
NPI:1962983890
Name:GARCIA-DIAZ, PATRICIA (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GARCIA-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 1:1001 CALLE AZABACHE
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2717
Mailing Address - Country:US
Mailing Address - Phone:787-553-3441
Mailing Address - Fax:
Practice Address - Street 1:URB. SAN MARTIN
Practice Address - Street 2:CALLE EMILIO R. DELGADO #1219
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-553-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist