Provider Demographics
NPI:1558130948
Name:ROMANES DIAZ, MAYELIN (TCM)
Entity Type:Individual
Prefix:
First Name:MAYELIN
Middle Name:
Last Name:ROMANES DIAZ
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:MAYELIN
Other - Middle Name:
Other - Last Name:ROMANES DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CBHCM
Mailing Address - Street 1:9100 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3228
Mailing Address - Country:US
Mailing Address - Phone:954-630-5680
Mailing Address - Fax:
Practice Address - Street 1:9100 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3228
Practice Address - Country:US
Practice Address - Phone:954-630-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0103947171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator