Provider Demographics
NPI:1891501813
Name:SANTOS AGOSTOS, DIAHNET LAURA
Entity type:Individual
Prefix:
First Name:DIAHNET
Middle Name:LAURA
Last Name:SANTOS AGOSTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 VIRGINIA PINE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3289
Mailing Address - Country:US
Mailing Address - Phone:407-844-7442
Mailing Address - Fax:
Practice Address - Street 1:1537 S ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8957
Practice Address - Country:US
Practice Address - Phone:407-484-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health