Provider Demographics
NPI:1831972603
Name:DIAZ, DAISYVETTE (TS)
Entity type:Individual
Prefix:MRS
First Name:DAISYVETTE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA TERESITA CALLE 56 BB 14
Mailing Address - Street 2:
Mailing Address - City:BAYAM0N
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8731
Mailing Address - Country:US
Mailing Address - Phone:787-975-3707
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA TERESITA CALLE 56 BB14 BAYAMON, PR
Practice Address - Street 2:N/A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-8731
Practice Address - Country:US
Practice Address - Phone:787-975-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty