Individual
GUILLERMO LUCERO DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
330 AVENUE C SE, WINTER HAVEN, FL 33880-3243
(863) 268-2903
Mailing address
330 AVENUE C SE, WINTER HAVEN, FL 33880-3243
(863) 268-2903
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA28397
FL
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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