Provider Demographics
NPI:1699905885
Name:VILCHEZ, DIANA K (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:K
Last Name:VILCHEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:K
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 SW 57TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5515
Mailing Address - Country:US
Mailing Address - Phone:786-529-2558
Mailing Address - Fax:
Practice Address - Street 1:7800 SW 57TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5515
Practice Address - Country:US
Practice Address - Phone:786-529-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9688OtherFLORIDA STATE