Basic Information
| Provider Information | |||||||||
| NPI: | 1568735074 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DIAZ | ||||||||
| FirstName: | LIZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2022 6TH AVE | ||||||||
| Address2: | STE 14 | ||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329605436 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2022 6TH AVE | ||||||||
| Address2: | STE 14 | ||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329605436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725647200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2012 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.