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MR. DESMOND L DIAZ

>> Massage Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1720210222

Individual Registrant:
MR. DESMOND L DIAZ 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
20726 W PENNSYLVANIA AVE  DUNNELLON, FL 34431-6717 US
Tel: 352-465-5880  Fax: 352-465-5889

Contact information for business:
20726 W PENNSYLVANIA AVE  DUNNELLON, FL 34431-6717 US
Tel: 352-465-5880  Fax: 352-465-5889

Registration Information:
NPI: 1720210222
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225700000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Massage Therapist
FLMA51192

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSEMA51192FL01




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