Healthcare Provider Details

I. General information

NPI: 1235880360
Provider Name (Legal Business Name): ALBA ROSELIN DIAZ ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15531 SW 133RD PL APT 711
MIAMI FL
33177-8112
US

IV. Provider business mailing address

15531 SW 133RD PL APT 711
MIAMI FL
33177-8112
US

V. Phone/Fax

Practice location:
  • Phone: 786-712-7993
  • Fax:
Mailing address:
  • Phone: 786-712-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: