Provider Demographics
NPI:1225570831
Name:DRA RAMONA DE LOURDES DIAZ JIMENEZ
Entity Type:Organization
Organization Name:DRA RAMONA DE LOURDES DIAZ JIMENEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:DE LOURDES
Authorized Official - Last Name:DIAZ JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-356-5376
Mailing Address - Street 1:513 SANTANA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6708
Mailing Address - Country:US
Mailing Address - Phone:787-356-5376
Mailing Address - Fax:787-881-4507
Practice Address - Street 1:513 SANTANA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-6708
Practice Address - Country:US
Practice Address - Phone:787-356-5376
Practice Address - Fax:787-881-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5660103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5660OtherTEM