Healthcare Provider Details

I. General information

NPI: 1306293295
Provider Name (Legal Business Name): BANIA URBAY DIAZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S ROYAL POINCIANA BLVD APT 406
MIAMI SPRINGS FL
33166-7274
US

IV. Provider business mailing address

433 S ROYAL POINCIANA BLVD APT 406
MIAMI SPRINGS FL
33166-7274
US

V. Phone/Fax

Practice location:
  • Phone: 786-923-6326
  • Fax:
Mailing address:
  • Phone: 786-923-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPTA26568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: