Provider Demographics
NPI:1659174720
Name:DIAZ, MASSIEL I (MD)
Entity type:Individual
Prefix:MISS
First Name:MASSIEL
Middle Name:
Last Name:DIAZ
Suffix:I
Gender:
Credentials:MD
Other - Prefix:MISS
Other - First Name:MASSIEL
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14700 SW SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1135
Mailing Address - Country:US
Mailing Address - Phone:786-461-7348
Mailing Address - Fax:786-461-7348
Practice Address - Street 1:14700 SW SUNSET DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1135
Practice Address - Country:US
Practice Address - Phone:786-461-7348
Practice Address - Fax:786-461-7348
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician