Provider Demographics
NPI:1548498702
Name:DIAZ, BLANCA T (DPM)
Entity type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:T
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 ARBOR HILL CIR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6510
Mailing Address - Country:US
Mailing Address - Phone:917-834-6874
Mailing Address - Fax:
Practice Address - Street 1:8554 PALM PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6432
Practice Address - Country:US
Practice Address - Phone:917-834-6874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00312900213ES0103X
390200000X
FLPO3688213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program