Individual
MR. DESMOND L DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20726 W PENNSYLVANIA AVE, DUNNELLON, FL 34431-6717
(352) 465-5880
(352) 465-5889
Mailing address
20726 W PENNSYLVANIA AVE, DUNNELLON, FL 34431-6717
(352) 465-5880
(352) 465-5889
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA51192
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA51192
STATE LICENSE
FL
Enumeration date
08/17/2009
Last updated
08/17/2009
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