MEDICARE: MRS. KATHERINE CABRERA-DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255101572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE CABRERA-DIAZ

Provider Business Mailing Address
First Line	:	4792 CORAL CASTLE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4792 CORAL CASTLE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6758
Country	:	US
Telephone Number	:	407-460-3349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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