Provider Demographics
NPI:1902111545
Name:DIAZ, RITA MARIA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARIA
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 1:7221 SW 24TH ST
Mailing Address - Street 2:SUITE 206-209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1436
Mailing Address - Country:US
Mailing Address - Phone:305-392-1493
Mailing Address - Fax:305-392-1495
Practice Address - Street 1:7221 SW 24TH ST
Practice Address - Street 2:SUITE 206-209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1436
Practice Address - Country:US
Practice Address - Phone:305-392-1493
Practice Address - Fax:305-392-1495
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48359172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist