Provider Demographics
NPI:1144824921
Name:MEDINA-DIAZ, CESAR A (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:A
Last Name:MEDINA-DIAZ
Suffix:
Gender:M
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L28 CALLE PINO
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2913
Mailing Address - Country:US
Mailing Address - Phone:787-832-7262
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 150.4
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist