Provider Demographics
NPI:1821448283
Name:KIWI LLC
Entity Type:Organization
Organization Name:KIWI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIAZ MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-436-4848
Mailing Address - Street 1:URB.PARAISO CALLE LEALTAD 118
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00680
Mailing Address - Country:UM
Mailing Address - Phone:787-436-4848
Mailing Address - Fax:
Practice Address - Street 1:BO.PASO SECO SECTOR USERAS CARR 153 KM7.5
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00757
Practice Address - Country:UM
Practice Address - Phone:787-436-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9088261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)