Provider Demographics
NPI:1932432309
Name:DIAZ, DORA DEL CARMEN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:DEL CARMEN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18781 SW 291ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3014
Mailing Address - Country:US
Mailing Address - Phone:305-248-6695
Mailing Address - Fax:
Practice Address - Street 1:18781 SW 291ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3014
Practice Address - Country:US
Practice Address - Phone:305-248-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37303247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other