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Individual

WANDA IVELISSE DIAZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
759 AVE AVELINO VICENTE, SAN JUAN, PR 00909-2538
(787) 410-5443
Mailing address
PO BOX 2510, JUNCOS, PR 00777-2510

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
930
PR

Other

Enumeration date
03/12/2013
Last updated
03/12/2013
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