Provider Demographics
NPI:1902611817
Name:ROMERO DIAZ, ANNELISSE
Entity type:Individual
Prefix:
First Name:ANNELISSE
Middle Name:
Last Name:ROMERO DIAZ
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 1:4001 SW 54TH CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6721
Mailing Address - Country:US
Mailing Address - Phone:954-907-7366
Mailing Address - Fax:
Practice Address - Street 1:4001 SW 54TH CT APT 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-6721
Practice Address - Country:US
Practice Address - Phone:954-907-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist