Provider Demographics
NPI:1013222140
Name:DIAZ NEVAREZ, WIDALYS (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:WIDALYS
Middle Name:
Last Name:DIAZ NEVAREZ
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:X9 CALLE 19
Mailing Address - Street 2:URB. LA ESPERANZA
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6840
Mailing Address - Country:US
Mailing Address - Phone:939-644-3435
Mailing Address - Fax:
Practice Address - Street 1:X9 CALLE 19
Practice Address - Street 2:URB. LA ESPERANZA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6840
Practice Address - Country:US
Practice Address - Phone:939-644-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist