MEDICARE: JANNIFER A 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	101YM0800X	Mental Health Counselor
2	2255A2300X	Athletic Trainer	MH16317	FL

General Provider Information

NPI Number	:	1457622714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNIFER A DIAZ

Provider Business Mailing Address
First Line	:	8001 SW 36TH ST
Second Line	:	SUITE 9
City	:	DAVIE
State	:	FL
Zip	:	33328-1915
Country	:	US
Telephone Number	:	954-577-7790
Fax Number	:	954-577-7780

Provider Business Practice Location Address
First Line	:	205 N DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-4522
Country	:	US
Telephone Number	:	954-744-9190
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	09/20/2023

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Directions to “ JANNIFER A DIAZ ” Practice Location

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