Healthcare Provider Details

I. General information

NPI: 1902111545
Provider Name (Legal Business Name): RITA MARIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 SW 24TH ST SUITE 206-209
MIAMI FL
33155-1436
US

IV. Provider business mailing address

7221 SW 24TH ST SUITE 206-209
MIAMI FL
33155-1436
US

V. Phone/Fax

Practice location:
  • Phone: 305-392-1493
  • Fax: 305-392-1495
Mailing address:
  • Phone: 305-392-1493
  • Fax: 305-392-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA48359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: