Provider Demographics
NPI:1144474495
Name:DIAZ, MARIA CECILIA (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SHADY PINE WAY
Mailing Address - Street 2:APT. B1
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9073
Mailing Address - Country:US
Mailing Address - Phone:561-702-6135
Mailing Address - Fax:
Practice Address - Street 1:3130 S CONGRESS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2552
Practice Address - Country:US
Practice Address - Phone:561-702-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist