Individual
MRS. STACIE S DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
17224 133RD AVE APT 11E, JAMAICA, NY 11434-3903
(917) 400-1294
Mailing address
17224 133RD AVE, SUITE 11E, JAMAICA, NY 11434-3955
(917) 400-1294
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
022590
NY
225700000X
Massage Therapist
Primary
022590
NY
Other
Enumeration date
07/02/2009
Last updated
02/02/2023
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