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General NPI Number Information
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NPI Number | 1134172505
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Entity Type | Individual
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Provider Name | CARMEN B DIAZ PHD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 2100 PONCE DE LEON BLVD STE 1015
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City | CORAL GABLES
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State | FL
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Zip | 33134-5240
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Country | US
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Telephone | 786-514-8812
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Fax | 305-274-0692
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Provider Business Mailing Address
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Address Line | 9421 SW 12TH ST
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City | MIAMI
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State | FL
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Zip | 33174-3027
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Country | US
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Telephone | 305-485-1552
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Fax | 305-274-0692
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4145
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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