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General NPI Number Information
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NPI Number | 1417544453
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Entity Type | Individual
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Provider Name | ERIK ALFONSO DIAZ JR. LMT
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Gender | Male
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 9910 SW 164TH CT
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City | MIAMI
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State | FL
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Zip | 33196-5824
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Country | US
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Telephone | 305-497-4351
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Fax |
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Provider Business Mailing Address
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Address Line | 14790 N KENDALL DR # 961434
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City | MIAMI
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State | FL
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Zip | 33196-1481
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Country | US
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Telephone | 305-203-3343
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA79072
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License Number State | FL
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