Provider Demographics
NPI:1346706777
Name:DIAZ RODRIGUEZ, LIMARIE (MS)
Entity Type:Individual
Prefix:MISS
First Name:LIMARIE
Middle Name:
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO QUINTA REAL
Mailing Address - Street 2:4206 CALLE REY ARTURO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-513-6259
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO QUINTA REAL
Practice Address - Street 2:4206 CALLE REY ARTURO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-513-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2023-03-10
Deactivation Date:2019-09-12
Deactivation Code:
Reactivation Date:2023-03-10
Provider Licenses
StateLicense IDTaxonomies
PR6049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist