Provider Demographics
NPI:1821484437
Name:DIAZ, RAUL A I
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:A
Last Name:DIAZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 HAMMOCKS BLVD APT 4302
Mailing Address - Street 2:8405 HAMMOCKS BLVD APT 4302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4176
Mailing Address - Country:US
Mailing Address - Phone:786-445-2100
Mailing Address - Fax:
Practice Address - Street 1:8405 HAMMOCKS BLVD APT 4302
Practice Address - Street 2:8405 HAMMOCKS BLVD APT 4302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-4176
Practice Address - Country:US
Practice Address - Phone:786-445-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker