Provider Demographics
NPI:1568001048
Name:DIETZ, MERCEDES E
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:E
Last Name:DIETZ
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 1:8329 BOCA RIO DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8304
Mailing Address - Country:US
Mailing Address - Phone:215-815-8161
Mailing Address - Fax:
Practice Address - Street 1:8329 BOCA RIO DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-8304
Practice Address - Country:US
Practice Address - Phone:215-815-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist