Provider Demographics
NPI:1912622564
Name:DIAZ, MARIEN G
Entity Type:Individual
Prefix:
First Name:MARIEN
Middle Name:G
Last Name:DIAZ
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 1:23701 SILVER DATE LOOP APT 103
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2866
Mailing Address - Country:US
Mailing Address - Phone:469-544-3343
Mailing Address - Fax:
Practice Address - Street 1:23701 SILVER DATE LOOP APT 103
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2866
Practice Address - Country:US
Practice Address - Phone:469-544-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health