Provider Demographics
NPI:1003024373
Name:DIAZ, EDUARDO I (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 SW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1010
Mailing Address - Country:US
Mailing Address - Phone:305-255-5817
Mailing Address - Fax:
Practice Address - Street 1:13625 SW 82ND CT
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1010
Practice Address - Country:US
Practice Address - Phone:305-255-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist