Active NPI
Coralys Pena Diaz, PSYD
- Clinical Psychologist
- Naranjito, PR
National Provider Identifier
1265007298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6863
- Practice address
- Carr 779 KM 10.1 Bo Cedro Arriba Sector El Abanico
Naranjito, PR 00719 - Phone
- (787) 236-2929
- NPI assigned
- May 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6863 | PR | Primary |
Addresses
Primary practice location
Carr 779 KM 10.1 Bo Cedro Arriba Sector El Abanico
Naranjito, PR 00719
Mailing address
PO Box 320
Comerio, PR 00782-0320
Phone (787) 483-3504
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6863 | Other | PR | PSYCHOLOGIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6863 | PR | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688083200000",
"number": "1265007298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 320",
"city": "COMERIO",
"state": "PR",
"postal_code": "007820320",
"telephone_number": "787-483-3504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CARR 779 KM 10.1 BO CEDRO ARRIBA SECTOR EL ABANICO",
"city": "NARANJITO",
"state": "PR",
"postal_code": "00719",
"telephone_number": "787-236-2929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENA DIAZ",
"first_name": "CORALYS",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-21",
"last_updated": "2023-06-30",
"certification_date": "2023-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "6863",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "6863",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Naranjito, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.