Provider Demographics
NPI:1265033666
Name:DIAZ RODRIGUEZ, ANA MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 NW 25TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1922
Mailing Address - Country:US
Mailing Address - Phone:786-804-9521
Mailing Address - Fax:
Practice Address - Street 1:10900 NW 25TH ST STE 104
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1922
Practice Address - Country:US
Practice Address - Phone:786-804-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD263013776270OtherFLORIDA DRIVERS LICENSE NUMBER