Provider Demographics
NPI:1649981465
Name:DIAZ RAMOS, WIGMAR (PH D)
Entity type:Individual
Prefix:
First Name:WIGMAR
Middle Name:
Last Name:DIAZ RAMOS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GLENVIEW
Mailing Address - Street 2:ENEAS F20
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-531-8479
Mailing Address - Fax:
Practice Address - Street 1:TORRE MEDICA SAN VICENTE DE PAUL
Practice Address - Street 2:SUITE 410
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-531-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty