MEDICARE: MICHELLE DIAZ CCMA

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1366291841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DIAZ CCMA

Provider Business Mailing Address
First Line	:	509 S CHICKASAW TRL # 273
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7801
Country	:	US
Telephone Number	:	407-758-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 S CHICKASAW TRL # 1044
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8414
Country	:	US
Telephone Number	:	407-758-1162
Fax Number	:

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “ MICHELLE DIAZ CCMA” Practice Location

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