Active NPI
Mariselee Diaz Conde
- Clinical Psychologist
- Bayamon, PR
National Provider Identifier
1619483906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5790
- Practice address
- 1 Calle Magnolia Gardens
A-28
Bayamon, PR 00959 - Phone
- (787) 439-8140
- Fax
- (787) 439-8140
- NPI assigned
- Dec 21, 2017
- Last updated
- Dec 21, 2017
- 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 | 5790 | PR | Primary |
Addresses
Primary practice location
1 Calle Magnolia Gardens
A-28
Bayamon, PR 00959
Mailing address
HC 645 Box 8167
Trujillo Alto, PR 00976-9772
Phone (787) 439-8140
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5790 | PR | MD | Interventional Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1619483906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 645 BOX 8167",
"city": "TRUJILLO ALTO",
"state": "PR",
"postal_code": "009769772",
"telephone_number": "787-439-8140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CALLE MAGNOLIA GARDENS",
"address_2": "A-28",
"city": "BAYAMON",
"state": "PR",
"postal_code": "00959",
"telephone_number": "787-439-8140",
"fax_number": "787-439-8140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ CONDE",
"first_name": "MARISELEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-21",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "5790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayamon, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.