Provider Demographics
NPI:1790138139
Name:DIAZ ESCOTO, MAILY C
Entity Type:Individual
Prefix:
First Name:MAILY
Middle Name:C
Last Name:DIAZ ESCOTO
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 1:125 NW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4529
Mailing Address - Country:US
Mailing Address - Phone:786-281-3276
Mailing Address - Fax:
Practice Address - Street 1:125 NW 18TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4529
Practice Address - Country:US
Practice Address - Phone:786-281-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician