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General NPI Number Information
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NPI Number | 1356005771
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Entity Type | Individual
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Provider Name | JAYMIELEE SOTO DIAZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 8207 FOREST CITY RD
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City | ORLANDO
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State | FL
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Zip | 32810-2354
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Country | US
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Telephone | 787-642-6147
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 SOLSTICE LOOP
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City | SANFORD
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State | FL
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Zip | 32771-0046
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Country | US
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Telephone | 787-642-6147
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11247
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License Number State | FL
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