Provider Demographics
NPI:1356889679
Name:DIAZ, CLARIBEL
Entity type:Individual
Prefix:
First Name:CLARIBEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARIBEL
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMH
Mailing Address - Street 1:8457 NARCOOSSEE RD APT 11203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5636
Mailing Address - Country:US
Mailing Address - Phone:407-277-7620
Mailing Address - Fax:
Practice Address - Street 1:100 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3231
Practice Address - Country:US
Practice Address - Phone:407-277-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH 1,479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health