Healthcare Provider Details

I. General information

NPI: 1194429795
Provider Name (Legal Business Name): MRS. MARIANA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA SANTO DO

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-4199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS23420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: