Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1865 | PR |
Y | 103TC0700X | Clinical Psychologist | 1865 | PR |
NPI | 1013127612 |
---|---|
Provider Name | Dr. Edith Rosado Diaz |
First Address | Dorado, PR 00646-5616 |
Second Address | Vega Alta, PR 00692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 06/12/2021 |