Provider Demographics
NPI:1558606269
Name:BALL-ROSA, DIANA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:S
Last Name:BALL-ROSA
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:CONDOMINIO PONCE DE LEON APT 306
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00966
Mailing Address - Country:UM
Mailing Address - Phone:787-793-6721
Mailing Address - Fax:787-897-2727
Practice Address - Street 1:AVE. LOS PATRIOTAS STRETT 111 KM 1.9
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-897-2725
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist