Provider Demographics
NPI:1669846366
Name:DIAZ, HILDA
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:
Last Name: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:H8 CALLE CEIBA
Mailing Address - Street 2:QUINTAS DE DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4714
Mailing Address - Country:US
Mailing Address - Phone:787-645-4977
Mailing Address - Fax:
Practice Address - Street 1:H8 CALLE CEIBA
Practice Address - Street 2:QUINTAS DE DORADO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4714
Practice Address - Country:US
Practice Address - Phone:787-645-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004108103T00000X, 103TB0200X, 103TC1900X, 103TH0004X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service