Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 001464 | PR |
NPI | 1023586351 |
---|---|
Provider Name | Mrs. Norma Zoe Diaz |
First Address | Carolina, PR 00985-5420 |
Second Address | Carolina, PR 00985-5420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001464 | VIMAR THERAPY GROUP (01) | PR |