Provider Demographics
NPI:1235393547
Name:DIAZ, LILLIAN MILAGROS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MILAGROS
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SABANERA DORADO
Mailing Address - Street 2:#342 CAMINO DEL EUCALIPTO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3622
Mailing Address - Country:US
Mailing Address - Phone:787-461-8455
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO STE. 407
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-461-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist