Provider Demographics
NPI:1275244790
Name:GARCIA DIAZ, MARTA LILIAN
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:LILIAN
Last Name:GARCIA 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 1:16012 SW 144TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6404
Mailing Address - Country:US
Mailing Address - Phone:516-491-5810
Mailing Address - Fax:
Practice Address - Street 1:3146 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3210
Practice Address - Country:US
Practice Address - Phone:786-953-8874
Practice Address - Fax:305-400-8638
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily