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1407973233 NPI number — LILLIAN PAULINE AGRESTA-DIAZ M.S.

NPI Number: 1407973233
Health Care Provider/Practitioner: LILLIAN PAULINE AGRESTA-DIAZ M.S.

Information about “1407973233” NPI (LILLIAN PAULINE AGRESTA-DIAZ M.S.) exists in 1407973233 in HTML format HTML  |  1407973233 in plain Text format TXT  |  1407973233 in PDF (Portable Document Format) PDF  |  1407973233 in an XML format XML  formats.

NPI Number : 1407973233 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407973233",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AGRESTA-DIAZ",
    "FirstName": "LILLIAN",
    "MiddleName": "PAULINE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3656 2ND PL SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VERO BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32968-3172",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-484-5395",
    "MailingAddressFaxNumber": "772-584-3204",
    "FirstLinePracticeLocationAddress": "3656 2ND PL SW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VERO BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32968-3172",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-484-5395",
    "PracticeLocationAddressFaxNumber": "772-584-3204",
    "EnumerationDate": "03/25/2007",
    "LastUpdateDate": "08/19/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "003505-1",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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