MEDICARE: MELBA DIAZ REYES

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1487941357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELBA DIAZ REYES

Provider Business Mailing Address
First Line	:	7205 N CORTEZ AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2638
Country	:	US
Telephone Number	:	813-625-4362
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 N CORTEZ AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2638
Country	:	US
Telephone Number	:	813-625-4362
Fax Number	:

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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Directions to “ MELBA DIAZ REYES ” Practice Location

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