Healthcare Provider Details

I. General information

NPI: 1235545567
Provider Name (Legal Business Name): NATACHA L. DIEMUNSCH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD MOUNT SINAI MEDICAL CENTER
MIAMI FL
33140-2948
US

IV. Provider business mailing address

4300 ALTON RD MOUNT SINAI MEDICAL CENTER
MIAMI FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108016
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058177
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: