Provider Demographics
NPI:1659118180
Name:DIAZ CRESPO, PRISCILLA (MD)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:DIAZ CRESPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 5523 BO. ARENAS SECTOR EL GUANO
Mailing Address - Street 2:PARCELA #17
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641
Mailing Address - Country:US
Mailing Address - Phone:787-530-2312
Mailing Address - Fax:
Practice Address - Street 1:CARR 5523 BO. ARENAS SECTOR EL GUANO
Practice Address - Street 2:PARCELA #17
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-530-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007942103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool