Provider Demographics
NPI:1548426752
Name:RIVERA-DIAZ, IRMA S
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:S
Last Name:RIVERA-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:SC13 PLAZA 4
Mailing Address - Street 2:LA MANSION
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4810
Mailing Address - Country:US
Mailing Address - Phone:787-543-9553
Mailing Address - Fax:
Practice Address - Street 1:SC13 PLAZA 4
Practice Address - Street 2:LA MANSION
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4810
Practice Address - Country:US
Practice Address - Phone:787-543-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical