Provider Demographics
NPI:1417544453
Name:DIAZ, ERIK ALFONSO JR (LMT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:ALFONSO
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14790 N KENDALL DR # 961434
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1481
Mailing Address - Country:US
Mailing Address - Phone:305-203-3343
Mailing Address - Fax:
Practice Address - Street 1:9910 SW 164TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5824
Practice Address - Country:US
Practice Address - Phone:305-497-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist