Provider Demographics
NPI:1134449440
Name:DIAZ, ILEANA (MSW)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B4 CALLE 3
Mailing Address - Street 2:JARDINES DEL CARIBE
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4408
Mailing Address - Country:US
Mailing Address - Phone:787-678-7639
Mailing Address - Fax:
Practice Address - Street 1:JARDINES DEL CARIBE
Practice Address - Street 2:B4
Practice Address - City:CAYEY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00736
Practice Address - Country:UM
Practice Address - Phone:787-678-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR113051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical