Provider Demographics
NPI:1992469969
Name:DIAZ-PORTELA, PATRICIA P (SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:DIAZ-PORTELA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:PILAR
Other - Last Name:DIAZ-PORTELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1441 SW 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2202
Mailing Address - Country:US
Mailing Address - Phone:305-541-3400
Mailing Address - Fax:305-541-4949
Practice Address - Street 1:1441 SW 1ST STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2202
Practice Address - Country:US
Practice Address - Phone:305-541-3400
Practice Address - Fax:305-541-3344
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist