Provider Demographics
NPI:1205082955
Name:DIAZ HERNANDEZ, EMMA ROSA (PHD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:ROSA
Last Name:DIAZ HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 AVE MUNOZ RIVERA
Mailing Address - Street 2:206-D
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2102
Mailing Address - Country:US
Mailing Address - Phone:787-766-4750
Mailing Address - Fax:
Practice Address - Street 1:867 AVE MUNOZ RIVERA
Practice Address - Street 2:206-D
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2102
Practice Address - Country:US
Practice Address - Phone:787-766-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR421103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling