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NPI Code Detail

MEDICARE: COMPREHENSIVE ASSESSMENT CENTER, INC.

MEDICARE: COMPREHENSIVE ASSESSMENT CENTER, INC.
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
1103G00000XClinical NeuropsychologistPY 7316FL
2103TC0700XClinical PsychologistPY6296FL

General Provider Information

NPI Number : 1811008683
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE ASSESSMENT CENTER, INC.
Provider Business Mailing Address
First Line : 6625 MIAMI LAKES DR E
Second Line : EXECUTIVE SUITE 328
City : MIAMI LAKES
State : FL
Zip : 33014-2708
Country : US
Telephone Number : 305-779-8565
Fax Number : 954-430-6742
Provider Business Practice Location Address
First Line : 6625 MIAMI LAKES DR E
Second Line : EXECUTIVE SUITE 328
City : MIAMI LAKES
State : FL
Zip : 33014-2708
Country : US
Telephone Number : 305-779-8565
Fax Number : 954-430-6742
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST/PRESIDENT
Name : DR. TANIA DIAZ
Credential : PSY.D.
Telephone Number : 305-779-8565
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/29/2014

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