Healthcare Provider Details

I. General information

NPI: 1649387655
Provider Name (Legal Business Name): MONICA JULIETH DIAZ R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

8617 SW 68TH CT APT 23
MIAMI FL
33143-7895
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-4455
  • Fax:
Mailing address:
  • Phone: 305-324-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number859477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: