Provider Demographics
NPI:1912860768
Name:DIAZ HERNANDEZ, MAYULI (SA-C)
Entity type:Individual
Prefix:
First Name:MAYULI
Middle Name:
Last Name:DIAZ HERNANDEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 SW 91ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1293
Mailing Address - Country:US
Mailing Address - Phone:786-854-0240
Mailing Address - Fax:
Practice Address - Street 1:14050 SW 91ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1293
Practice Address - Country:US
Practice Address - Phone:786-854-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2977363AS0400X, 363A00000X
FL25-296246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant