Provider Demographics
NPI:1356698641
Name:DIAZ-MIRANDA, ANA ROSA (MA)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:ROSA
Last Name:DIAZ-MIRANDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CB6 CALLE EUCALIPTOS
Mailing Address - Street 2:RIOHONDO III,
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3422
Mailing Address - Country:US
Mailing Address - Phone:787-613-0290
Mailing Address - Fax:787-785-3985
Practice Address - Street 1:CB6 CALLE EUCALIPTOS
Practice Address - Street 2:RIOHONDO III,
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3422
Practice Address - Country:US
Practice Address - Phone:787-613-0290
Practice Address - Fax:787-785-3985
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4258103TC1900X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic