Provider Demographics
NPI:1194874396
Name:DIAZ-MORENO, ELIZABETH M (SA7971)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:DIAZ-MORENO
Suffix:
Gender:F
Credentials:SA7971
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 W FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2837
Mailing Address - Country:US
Mailing Address - Phone:407-346-6530
Mailing Address - Fax:
Practice Address - Street 1:140 N ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3606
Practice Address - Country:US
Practice Address - Phone:407-407-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist