Provider Demographics
NPI:1942433008
Name:DIAZ OLIVERA, ERNESTO (MSC CCC SLP)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:DIAZ OLIVERA
Suffix:
Gender:M
Credentials:MSC CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SW 85TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4063
Mailing Address - Country:US
Mailing Address - Phone:786-728-0141
Mailing Address - Fax:
Practice Address - Street 1:8491 NW 17TH ST STE 113
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1025
Practice Address - Country:US
Practice Address - Phone:305-456-5542
Practice Address - Fax:305-456-8779
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist