Provider Demographics
NPI:1245433382
Name:DIAZ-PERES, VANESSA I (CCSS)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:I
Last Name:DIAZ-PERES
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CALLE MIGUEL RIVERA TEXIDOR
Mailing Address - Street 2:URB. ESTANCIAS DEL GOLF
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0501
Mailing Address - Country:US
Mailing Address - Phone:787-259-4863
Mailing Address - Fax:
Practice Address - Street 1:136 CALLE MIGUEL RIVERA TEXIDOR
Practice Address - Street 2:URB. ESTANCIAS DEL GOLF
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-0501
Practice Address - Country:US
Practice Address - Phone:787-259-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor