Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 895 | PR |
NPI | 1033636642 |
---|---|
Provider Name | Diodanny Diaz Santana |
First Address | Toa Baja, PR 00949-3901 |
Second Address | Toa Baja, PR 00949-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2017 |
Last Update Date | 24/08/2017 |