Provider Demographics
NPI:1902466550
Name:BUITRAGO DIAZ, CYNTHIA LISETTE (MS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LISETTE
Last Name:BUITRAGO DIAZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 RIVER PARK CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7233
Mailing Address - Country:US
Mailing Address - Phone:813-712-9975
Mailing Address - Fax:
Practice Address - Street 1:2001 RIVER PARK CT
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7233
Practice Address - Country:US
Practice Address - Phone:813-712-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist