Provider Demographics
NPI:1508595778
Name:MATOS, DIANE (PSYD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MATOS
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:J-7 CALLE OSCAR COLLAZO
Mailing Address - Street 2:EL ROSARIO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5718
Mailing Address - Country:US
Mailing Address - Phone:787-501-3925
Mailing Address - Fax:
Practice Address - Street 1:J-7 CALLE OSCAR COLLAZO
Practice Address - Street 2:EL ROSARIO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5718
Practice Address - Country:US
Practice Address - Phone:787-501-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical