MEDICARE: DR. RAUL DIAZ PH.D.

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	103TC0700X	Clinical Psychologist	PY0003808	FL

General Provider Information

NPI Number	:	1831132703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL DIAZ PH.D.

Provider Business Mailing Address
First Line	:	3865 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2853
Country	:	US
Telephone Number	:	567-966-8423
Fax Number	:	561-966-8424

Provider Business Practice Location Address
First Line	:	3865 10TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2853
Country	:	US
Telephone Number	:	567-966-8423
Fax Number	:	561-966-8424

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/14/2009

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