Provider Demographics
NPI:1326730631
Name:CARRIO DIAZ, TALYSHA
Entity Type:Individual
Prefix:
First Name:TALYSHA
Middle Name:
Last Name:CARRIO DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 CARR 844 APT 73
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9575
Mailing Address - Country:US
Mailing Address - Phone:787-429-7170
Mailing Address - Fax:
Practice Address - Street 1:MONTE ATENAS OFFICE PARK, PR 199 LAS CUMBRES
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-662-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1027-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist