Provider Demographics
NPI:1265674212
Name:DIAZ-MACHADO, IVETTE M (PSYD)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:M
Last Name:DIAZ-MACHADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANTA CLARA
Mailing Address - Street 2:S 21 PALMA REAL ST
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6819
Mailing Address - Country:US
Mailing Address - Phone:939-244-7950
Mailing Address - Fax:
Practice Address - Street 1:VICK CENTER B 102
Practice Address - Street 2:867 AVE MUNOZ RIVERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2140
Practice Address - Country:US
Practice Address - Phone:939-244-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical