Individual
MISS KEILAH AMARYLLIS DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
42 STAFFORD AVE APT B1, BRISTOL, CT 06010-4610
(203) 952-9134
Mailing address
74 EAST ST, PLAINVILLE, CT 06062-2367
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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