Provider Demographics
NPI:1609193986
Name:DIAZ, GLORIANGIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:GLORIANGIE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 2612
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-6405
Mailing Address - Country:US
Mailing Address - Phone:787-466-5294
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 2612
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-6405
Practice Address - Country:US
Practice Address - Phone:787-466-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3370103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool