MEDICARE: MARIA CECILIA DIAZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA42794	FL

General Provider Information

NPI Number	:	1144474495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CECILIA DIAZ LMT

Provider Business Mailing Address
First Line	:	530 SHADY PINE WAY
Second Line	:	APT. B1
City	:	GREENACRES
State	:	FL
Zip	:	33415-9073
Country	:	US
Telephone Number	:	561-702-6135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 S CONGRESS AVE
Second Line	:	SUITE B
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2552
Country	:	US
Telephone Number	:	561-702-6135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	10/13/2010

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