Individual
MRS. CARMEN B DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2100 PONCE DE LEON BLVD STE 1015, CORAL GABLES, FL 33134-5240
(786) 514-8812
(305) 274-0692
Mailing address
9421 SW 12TH ST, MIAMI, FL 33174-3027
(305) 485-1552
(305) 274-0692
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
PY4145
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PY4145
MEDICAL LICENSE #
FL
Enumeration date
05/18/2006
Last updated
09/05/2023
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