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General NPI Number Information
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NPI Number | 1194874396
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Entity Type | Individual
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Provider Name | ELIZABETH M DIAZ-MORENO SA7971
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 140 N ORLANDO AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3606
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Country | US
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Telephone | 407-407-6227
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Fax |
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Provider Business Mailing Address
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Address Line | 1251 W FOREST LAKE DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-2837
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Country | US
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Telephone | 407-346-6530
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA7971
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License Number State | FL
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