Healthcare Provider Details

I. General information

NPI: 1760393466
Provider Name (Legal Business Name): CLAUDIA NICOLE DIAZ-ROBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 STACK BLVD
MELBOURNE FL
32901-8561
US

IV. Provider business mailing address

1710 BROOKSHIRE CIR
MELBOURNE FL
32904-6668
US

V. Phone/Fax

Practice location:
  • Phone: 321-587-3220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: