Provider Demographics
NPI:1346757002
Name:DIAZ, DIADENIS SR (PERSONAL)
Entity Type:Individual
Prefix:MS
First Name:DIADENIS
Middle Name:
Last Name:DIAZ
Suffix:SR
Gender:F
Credentials:PERSONAL
Other - Prefix:MS
Other - First Name:DIADENIS
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9243 NW 121ST TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4224
Mailing Address - Country:US
Mailing Address - Phone:305-910-7239
Mailing Address - Fax:
Practice Address - Street 1:9243 NW 121ST TER
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4224
Practice Address - Country:US
Practice Address - Phone:305-910-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19869Medicaid