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General NPI Number Information
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NPI Number | 1801801600
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Entity Type | Organization
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Legal Business Name | DR CARMEN DIAZ PA
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 2100 PONCE DE LEON BLVD STE 1015
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City | CORAL GABLES
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State | FL
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Zip | 33134-5240
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Country | US
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Telephone | 786-514-8812
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Fax |
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Provider Business Mailing Address
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Address Line | 5563 SW 6TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1057
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Country | US
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Telephone | 786-514-8812
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, DIRECTOR
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Name | MRS. CARMEN B DIAZ
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Credential | PHD
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Telephone | 786-514-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4145
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License Number State | FL
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