Provider Demographics
NPI:1003861097
Name:PICO-GUARDADO, DAIMA (PSYD)
Entity Type:Individual
Prefix:
First Name:DAIMA
Middle Name:
Last Name:PICO-GUARDADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2706
Mailing Address - Country:US
Mailing Address - Phone:305-532-7246
Mailing Address - Fax:305-534-3974
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-532-7246
Practice Address - Fax:305-534-3974
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY005556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54139OtherBLUE CROSS BLUE SHIELD
FL54139OtherBLUE CROSS BLUE SHIELD