Provider Demographics
NPI:1295405751
Name:ZULUAGA DIAZ, MARIA ALEJANDRA (MSW RCSWI)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:ZULUAGA DIAZ
Suffix:
Gender:F
Credentials:MSW RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 DALE MABRY HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-3031
Mailing Address - Country:US
Mailing Address - Phone:813-434-3639
Mailing Address - Fax:
Practice Address - Street 1:18918 DUQUESNE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3423
Practice Address - Country:US
Practice Address - Phone:813-808-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ISW16194101YM0800X
FLSW223621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health