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Provider Information for 1346624483


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ROBERTO DIAZ LMHC, NCC


Sex: Male

NPI: 1346624483
Last Updated: 2015-07-18
Certification Date:

Details

NameValue
NPI1346624483
Enumeration Date2015-07-18
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 2645 EXECUTIVE PARK DR
SUITE 513
WESTON, FL 33331-3624
United States

Phone: | Fax:
 
Primary Practice Address 11850 NW 41ST ST
SUNRISE, FL 33323-3612
United States

Phone: 954-673-9408 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthFLMH6578