Provider Demographics
NPI:1396988606
Name:MARISCAL, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MARISCAL
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 1:5836 PETUNIA LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5511
Mailing Address - Country:US
Mailing Address - Phone:407-731-4511
Mailing Address - Fax:
Practice Address - Street 1:5836 PETUNIA LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-5511
Practice Address - Country:US
Practice Address - Phone:407-731-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2676OtherACUPUNCTURE
FLMA44739OtherMASSAGE THERAPY