Provider Demographics
NPI:1306293295
Name:URBAY DIAZ, BANIA (PTA)
Entity type:Individual
Prefix:
First Name:BANIA
Middle Name:
Last Name:URBAY DIAZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S ROYAL POINCIANA BLVD
Mailing Address - Street 2:APT 406
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7274
Mailing Address - Country:US
Mailing Address - Phone:786-923-6326
Mailing Address - Fax:
Practice Address - Street 1:433 S ROYAL POINCIANA BLVD
Practice Address - Street 2:APT 406
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7274
Practice Address - Country:US
Practice Address - Phone:786-923-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26568171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA26568OtherNPI