Provider Demographics
NPI:1134549983
Name:ARRIOLA, DIANA LIZ
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LIZ
Last Name:ARRIOLA
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:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-284-4554
Mailing Address - Fax:813-405-3722
Practice Address - Street 1:5611 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3532
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-738-9012
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160070208000000X
MS28038208000000X
LA305014208000000X
TXS0617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118973100Medicaid
LA2362054Medicaid