Provider Demographics
NPI:1942624929
Name:THE DIVERSITY INITIATIVE
Entity Type:Organization
Organization Name:THE DIVERSITY INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBANIC
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:813-850-4736
Mailing Address - Street 1:9250 BAY PLAZA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4465
Mailing Address - Country:US
Mailing Address - Phone:813-644-6829
Mailing Address - Fax:813-644-3830
Practice Address - Street 1:9250 BAY PLAZA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4465
Practice Address - Country:US
Practice Address - Phone:813-644-6829
Practice Address - Fax:813-644-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0161185275Medicaid