Provider Demographics
NPI:1841505922
Name:DIAZ, MOISES JOEL
Entity type:Individual
Prefix:MR
First Name:MOISES
Middle Name:JOEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 7053
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0000
Mailing Address - Country:US
Mailing Address - Phone:787-586-0214
Mailing Address - Fax:
Practice Address - Street 1:CARR. 198 KM 2.7
Practice Address - Street 2:BO. QUEBRADA ARENAS
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-0000
Practice Address - Country:US
Practice Address - Phone:787-942-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3369103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling