Provider Demographics
NPI:1295048072
Name:DIAZ, AMARILIS (ATO)
Entity type:Individual
Prefix:MISS
First Name:AMARILIS
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ATO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 23 BOX 6273
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9711
Mailing Address - Country:US
Mailing Address - Phone:787-313-8149
Mailing Address - Fax:
Practice Address - Street 1:HC 23 BOX 6273
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-9711
Practice Address - Country:US
Practice Address - Phone:787-313-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR749283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital