Provider Demographics
NPI:1043697493
Name:DIAZ, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5373 W 6TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2512
Mailing Address - Country:US
Mailing Address - Phone:305-335-5495
Mailing Address - Fax:305-397-1287
Practice Address - Street 1:5373 W 6TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2512
Practice Address - Country:US
Practice Address - Phone:305-335-5495
Practice Address - Fax:305-397-1287
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker