Provider Demographics
NPI:1265730410
Name:DIAZ-HERRERA, PEDRO ENRIQUE (LMT)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:ENRIQUE
Last Name:DIAZ-HERRERA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SW 8TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4938
Mailing Address - Country:US
Mailing Address - Phone:788-353-2604
Mailing Address - Fax:786-353-2645
Practice Address - Street 1:2260 SW 8TH ST STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4938
Practice Address - Country:US
Practice Address - Phone:788-353-2604
Practice Address - Fax:786-353-2645
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 46170225700000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist