Provider Demographics
NPI:1629366869
Name:CHIRINO DIAZ, MARKEL A (MA)
Entity Type:Individual
Prefix:
First Name:MARKEL
Middle Name:A
Last Name:CHIRINO DIAZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13190 SW 134TH ST UNIT E-105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4459
Mailing Address - Country:US
Mailing Address - Phone:305-763-5657
Mailing Address - Fax:
Practice Address - Street 1:13190 SW 134TH ST UNIT E-105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4459
Practice Address - Country:US
Practice Address - Phone:305-763-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist