Provider Demographics
NPI:1053548875
Name:DIAZ, TANIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR
Mailing Address - Street 2:SUITE 328
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2708
Mailing Address - Country:US
Mailing Address - Phone:305-779-8565
Mailing Address - Fax:305-779-8564
Practice Address - Street 1:6625 MIAMI LAKES DR
Practice Address - Street 2:SUITE 328
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-779-8565
Practice Address - Fax:305-779-8564
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical