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General NPI Number Information
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NPI Number | 1144177460
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Entity Type | Organization
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Legal Business Name | MELISSA COSTERO DIAZ PSY D PA
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 7900 SW 57TH AVE STE 24
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5546
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Country | US
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Telephone | 786-750-1837
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Fax |
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Provider Business Mailing Address
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Address Line | 7329 PINE VALLEY DR
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City | HIALEAH
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State | FL
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Zip | 33015-2228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA COSTERO
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Credential | PSYD
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Telephone | 708-369-6846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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