Provider Demographics
NPI:1679767149
Name:DIAZ, TANIA (MS)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TAINO STREET K-21 BRISAS DE MONTECASINO
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3842
Mailing Address - Country:US
Mailing Address - Phone:787-552-0409
Mailing Address - Fax:787-251-8573
Practice Address - Street 1:AVE. MUNOZ RIVERA 500 EL CENTRO II BUILDING
Practice Address - Street 2:SUITES 606 - 607
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-764-2860
Practice Address - Fax:787-751-5935
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR566231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist