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General NPI Number Information
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NPI Number | 1053096347
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Entity Type | Individual
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Provider Name | MARIELA DIAZ ALONSO ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1650 SAND LAKE RD STE 114A
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City | ORLANDO
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State | FL
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Zip | 32809-7712
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Country | US
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Telephone | 407-988-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 CRAGGY BLUFF PL
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City | COCOA
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State | FL
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Zip | 32926-7419
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Country | US
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Telephone | 321-394-5540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11025631
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License Number State | FL
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