Provider Demographics
NPI:1275866451
Name:DIAZ, MAYDEL (BS)
Entity Type:Individual
Prefix:
First Name:MAYDEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3055
Mailing Address - Country:US
Mailing Address - Phone:786-397-2061
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:3200 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3055
Practice Address - Country:US
Practice Address - Phone:786-397-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator