Provider Demographics
NPI:1053932350
Name:DIAZ, MARIANA CAROLINA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:CAROLINA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 PINE BRANCH DR APT 103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3501
Mailing Address - Country:US
Mailing Address - Phone:786-397-4676
Mailing Address - Fax:
Practice Address - Street 1:3141 PINE BRANCH DR APT 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3501
Practice Address - Country:US
Practice Address - Phone:786-397-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-015490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJDCATEMP-015490OtherMEDICAL LICENSE