Provider Demographics
NPI:1861251647
Name:MORI DIAZ, TAMARA YALI
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:YALI
Last Name:MORI DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E1 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4308
Mailing Address - Country:US
Mailing Address - Phone:939-525-0225
Mailing Address - Fax:
Practice Address - Street 1:906 CALLE DR VIRGILIO BIAGGI
Practice Address - Street 2:URB VILLA GRILLASCA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1108
Practice Address - Country:US
Practice Address - Phone:787-840-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1391224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant