Provider Demographics
NPI:1639701485
Name:DIAZ RODRIGUEZ, EDUARDO (MA)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:M
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:A29 CALLE MARGINAL
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3759
Mailing Address - Country:US
Mailing Address - Phone:787-556-9937
Mailing Address - Fax:
Practice Address - Street 1:CALLE DEL CARMEN #9 (2DO. PISO) FAJARDO PUEBLO
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0073
Practice Address - Country:US
Practice Address - Phone:787-556-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6048103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling