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General NPI Number Information
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NPI Number | 1063184653
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Entity Type | Individual
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Provider Name | RAQUEL DIAZ RDH
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Gender | Female
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 901 US HIGHWAY 27 N STE 60
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City | SEBRING
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State | FL
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Zip | 33870-2129
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Country | US
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Telephone | 863-471-1176
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Fax |
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Provider Business Mailing Address
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Address Line | 3277 COUNTRY HILL RD
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City | SEBRING
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State | FL
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Zip | 33872-3346
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Country | US
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Telephone | 863-441-4602
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH22461
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License Number State | FL
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