Provider Demographics
NPI:1134605330
Name:DIAZ, EBONY CRUZ INEZ
Entity type:Individual
Prefix:MS
First Name:EBONY CRUZ
Middle Name:INEZ
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PEER SPECIALIST
Mailing Address - Street 1:804 PAR DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1159
Mailing Address - Country:US
Mailing Address - Phone:786-443-1252
Mailing Address - Fax:
Practice Address - Street 1:804 PAR DR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1159
Practice Address - Country:US
Practice Address - Phone:786-443-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist