1346706777 NPI number — MISS LIMARIE DIAZ RODRIGUEZ PSYD

Table of content: MISS LIMARIE DIAZ RODRIGUEZ PSYD (NPI 1346706777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346706777 NPI number — MISS LIMARIE DIAZ RODRIGUEZ PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ RODRIGUEZ
Provider First Name:
LIMARIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346706777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/12/2019
NPI Reactivation Date:
03/10/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URBANIZACION VEREDAS 601
Provider Second Line Business Mailing Address:
CAMINO LOS JAZMINES
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-513-6259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VEREDAS 601
Provider Second Line Business Practice Location Address:
CAMINO LOS JAZMINES
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-513-6259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6049 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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