Provider Demographics
NPI:1508229386
Name:DIAZ SANQUINTIN, MARIA ORQUIDEA
Entity Type:Individual
Prefix:
First Name:MARIA ORQUIDEA
Middle Name:
Last Name:DIAZ SANQUINTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6943
Mailing Address - Country:US
Mailing Address - Phone:321-220-0206
Mailing Address - Fax:
Practice Address - Street 1:409 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6943
Practice Address - Country:US
Practice Address - Phone:321-220-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator