Healthcare Provider Details

I. General information

NPI: 1730604216
Provider Name (Legal Business Name): MARTA MARIA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 09/29/2026
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11177 N KENDALL DR APT H206
MIAMI FL
33176-0963
US

IV. Provider business mailing address

11225 N KENDALL DR APT D104
MIAMI FL
33176-1132
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-0223
  • Fax:
Mailing address:
  • Phone: 786-262-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: