Provider Demographics
NPI:1861365710
Name:CENTENO DIAZ, MAXILIZ
Entity type:Individual
Prefix:
First Name:MAXILIZ
Middle Name:
Last Name:CENTENO DIAZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE DOCTOR GOYCO ESQUINA
Practice Address - Street 2:ACOSTA LOCAL 202
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9998
Practice Address - Country:US
Practice Address - Phone:787-638-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant