Provider Demographics
NPI:1326288200
Name:DIAZ, ANESKA ROSARIO SR (PSICOLOGIST CLINICO)
Entity Type:Individual
Prefix:DR
First Name:ANESKA
Middle Name:ROSARIO
Last Name:DIAZ
Suffix:SR
Gender:F
Credentials:PSICOLOGIST CLINICO
Other - Prefix:DR
Other - First Name:ANESKA
Other - Middle Name:ROSARIO
Other - Last Name:DIAZ
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:PSICOLOGIST CLINICO
Mailing Address - Street 1:PO BOX 3097
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-462-8737
Mailing Address - Fax:
Practice Address - Street 1:URB. ONEILL
Practice Address - Street 2:CALLE B #12
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-462-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3299103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical