Provider Demographics
NPI:1215176615
Name:DIAZ-FERNANDEZ, TANIA MARIA (MSED, OTR/L, C-SIPT)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:MARIA
Last Name:DIAZ-FERNANDEZ
Suffix:
Gender:F
Credentials:MSED, OTR/L, C-SIPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SW 73RD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4679
Mailing Address - Country:US
Mailing Address - Phone:786-662-5080
Mailing Address - Fax:786-662-5081
Practice Address - Street 1:6200 SW 73RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4679
Practice Address - Country:US
Practice Address - Phone:786-662-5080
Practice Address - Fax:786-662-5081
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5247225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010058700Medicaid
1982688230OtherHOSPITAL NPI NUMBER