Provider Demographics
NPI:1376980722
Name:DIAZ, SARA ALEJANDRA (CNA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ALEJANDRA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MENDEL LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2645
Mailing Address - Country:US
Mailing Address - Phone:407-575-6463
Mailing Address - Fax:321-567-5407
Practice Address - Street 1:401 MENDEL LN
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2645
Practice Address - Country:US
Practice Address - Phone:407-575-6463
Practice Address - Fax:321-567-5407
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL186096376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide