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General NPI Number Information
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NPI Number | 1548073216
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Entity Type | Individual
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Provider Name | ANDREA NATALIA DIAZ LOPEZ DC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3429 W UNIVERSITY AVE
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City | GAINESVILLE
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State | FL
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Zip | 32607-2402
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Country | US
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Telephone | 352-681-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 FLORAL SPRINGS BLVD UNIT 5102
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City | PORT ORANGE
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State | FL
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Zip | 32129-6803
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Country | US
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Telephone | 787-616-2738
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH15362
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License Number State | FL
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