Healthcare Provider Details

I. General information

NPI: 1124817796
Provider Name (Legal Business Name): DIANA PATRICIA MURILLO VALDIVIESO RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 13TH ST
SAINT CLOUD FL
34769-4749
US

IV. Provider business mailing address

10124 MOSS ROSE WAY
ORLANDO FL
32832-5840
US

V. Phone/Fax

Practice location:
  • Phone: 407-749-3580
  • Fax:
Mailing address:
  • Phone: 407-747-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: