DR CARMEN DIAZ PA
Psychologist at Ponce De Leon Blvd, Miami, FL

License number
Florida PY4145
Category
Psychologist
Type
Psychologist
Owner
Name: MRS. CARMEN B DIAZ PHD
Title: PRESIDENT, DIRECTOR
Phone: (786) 514-8812
Address
Address
2100 Ponce De Leon Blvd STE 1015, Miami, FL 33134
National Provider ID: 1801801600
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DR. CARMEN DIAZ, PA

Miami, FL

Registration:
Feb 6, 2006
Addresses:
2100 Ponce De Leon Blvd SUITE 1015, Miami, FL 33134 (Physical)
5563 SW 6, Miami, FL 33134 (Mailing)
9421 SW 12 St, Miami, FL 33174
State ID:
P06000017885
Business type:
Florida Profit Corporation
Director:
Carmen Diaz (Director), 5563 SW 6, Miami, FL 33134 (Physical)
Agent:
Diaz, Carmen,5563 SW 6, Miami, FL 33134 (Physical)
EIN:
20-4262575

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