Healthcare Provider Details

I. General information

NPI: 1104608306
Provider Name (Legal Business Name): NATALIA A DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 WILDBRIAR RD NE APT 304
PALM BAY FL
32905-6211
US

IV. Provider business mailing address

790 WILDBRIAR RD NE APT 304
PALM BAY FL
32905-6211
US

V. Phone/Fax

Practice location:
  • Phone: 787-231-2603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number14322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: