Provider Demographics
NPI:1487296778
Name:DIAZ, KARLA MICHELLE (LPN, MSCP)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPN, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 MARYLEBONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-3901
Mailing Address - Country:US
Mailing Address - Phone:407-375-7277
Mailing Address - Fax:
Practice Address - Street 1:5424 MARYLEBONE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-3901
Practice Address - Country:US
Practice Address - Phone:407-375-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health