Provider Demographics
NPI:1568193233
Name:DIAZ, LUIS ALFREDO (MS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALFREDO
Last Name:DIAZ
Suffix:
Gender:M
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:S21 CALLE CLAVELILLO
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3216
Mailing Address - Country:US
Mailing Address - Phone:787-515-0989
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO.2 KM 8.2
Practice Address - Street 2:BO. JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-515-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6767103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)