Doctor Name: | MRS. DIANE DIAZ RODRIGUEZ |
NPI Number: | 1093176893 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | IMH 14439 |
License Number: | IMH 14439 |
Business Practice Address: | 167 Ridgemont Cir Se Palm Bay, FL - 329092318 |
Business Phone Number: | 8503136207 |
Business Fax Number: | |
Mailing Address: | 1009 Maitland Center Commons Blvd Ste 212, MAITLAND |
State: | FL |
Postal Code: | 327517270 |
Phone Number: | 8503136207 |
Fax Number: | |
NPI Enumeration Date: | 03/08/2016 |
NPI Last Update Date: | 03/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMH 14439 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |