Provider Demographics
NPI:1619795655
Name:SANTAMARIA PRIETO, DIANA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:DIANA DE LA CARIDAD
Middle Name:
Last Name:SANTAMARIA PRIETO
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 1:317 NE 26 TH TERR
Mailing Address - Street 2:UNIT 101
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7037
Mailing Address - Country:US
Mailing Address - Phone:305-992-3287
Mailing Address - Fax:
Practice Address - Street 1:371 NE 26TH TER UNIT 101
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7037
Practice Address - Country:US
Practice Address - Phone:305-992-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-377041106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty