Provider Demographics
NPI:1164968707
Name:PIMENTEL DIAZ, OSMARY JOANNE
Entity Type:Individual
Prefix:
First Name:OSMARY
Middle Name:JOANNE
Last Name:PIMENTEL 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 1:6501 SW 139TH CT APT 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2089
Mailing Address - Country:US
Mailing Address - Phone:757-358-1030
Mailing Address - Fax:
Practice Address - Street 1:6501 SW 139TH CT APT 402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2089
Practice Address - Country:US
Practice Address - Phone:757-358-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician