1760219166 NPI number — LIENG DE LA CARIDAD DIAZ VALDES RBT

Table of content: LIENG DE LA CARIDAD DIAZ VALDES RBT (NPI 1760219166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760219166 NPI number — LIENG DE LA CARIDAD DIAZ VALDES RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ VALDES
Provider First Name:
LIENG
Provider Middle Name:
DE LA CARIDAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760219166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15320 SW 297TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33033-3655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-608-6874
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 NW 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33030-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-410-9806
Provider Business Practice Location Address Fax Number:
786-610-0605
Provider Enumeration Date:
09/18/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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