Provider Demographics
NPI:1497504625
Name:DIAZ-QUINTANA, EGLINDINA (MSW)
Entity type:Individual
Prefix:MISS
First Name:EGLINDINA
Middle Name:
Last Name:DIAZ-QUINTANA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 KENWOOD LN STE 213
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5648
Mailing Address - Country:US
Mailing Address - Phone:239-537-9646
Mailing Address - Fax:
Practice Address - Street 1:12811 KENWOOD LN STE 213
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5648
Practice Address - Country:US
Practice Address - Phone:239-537-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical