Provider Demographics
NPI:1871225565
Name:DIAZ, ANDREA (BA)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 ZONA INDUSTRIAL REPARADA 2
Practice Address - Street 2:CALLE DR. LUIS F. SALA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2348
Practice Address - Country:US
Practice Address - Phone:787-840-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program