Provider Demographics
NPI:1114178100
Name:DIAZ, HECTOR LUIS
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:LUIS
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CALLE ALELI
Mailing Address - Street 2:URB MONTE ELENA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5601
Mailing Address - Country:US
Mailing Address - Phone:787-402-5154
Mailing Address - Fax:787-796-5411
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker