Provider Demographics
NPI:1194715144
Name:BARALT, DIANA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:BARALT
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 1:1118 CAPRI ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2406
Mailing Address - Country:US
Mailing Address - Phone:305-856-2002
Mailing Address - Fax:305-856-0550
Practice Address - Street 1:2251 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3433
Practice Address - Country:US
Practice Address - Phone:305-856-2002
Practice Address - Fax:305-856-0550
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00724032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38066OtherBLUE CROSS BLUE SHIELD NO
FL38066AMedicare PIN
FL38066OtherBLUE CROSS BLUE SHIELD NO