Individual
SANDRA R DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 GRAN BAHAMA BLVD, DAVENPORT, FL 33897-8322
(407) 549-8569
Mailing address
400 GRAN BAHAMA BLVD, DAVENPORT, FL 33897-8322
(407) 549-8569
Taxonomy
Speciality
Code
Description
License number
State
344600000X
Taxi
Primary
D200796827620
FL
Other
Enumeration date
10/24/2017
Last updated
03/17/2018
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