Provider Demographics
NPI:1003677329
Name:DIAZ CAPARROZ, MIRELIS
Entity Type:Individual
Prefix:
First Name:MIRELIS
Middle Name:
Last Name:DIAZ CAPARROZ
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:BO. PUENTE SECTOR ZARZA
Mailing Address - Street 2:CARRETERA 119 K 6.0
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:939-253-7441
Mailing Address - Fax:
Practice Address - Street 1:BO. PUENTE SECTOR ZARZA
Practice Address - Street 2:CARRETERA 119 K 6.0
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:939-253-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR156591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical