Provider Demographics
NPI:1003376864
Name:DIAZ ALVAREZ, VIVIAN M (SLP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:DIAZ ALVAREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 FONTAINEBLEAU BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4240
Mailing Address - Country:US
Mailing Address - Phone:786-646-7751
Mailing Address - Fax:
Practice Address - Street 1:5470 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2105
Practice Address - Country:US
Practice Address - Phone:305-456-2646
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist