Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MA89791 | FL |
N | 2081S0010X | Sports Medicine | MA89791 | FL |
N | 213ES0000X | Sports Medicine | MA89791 | FL |
NPI | 1336798156 |
---|---|
Provider Name | Anisley Lanza Diaz |
First Address | Tampa, FL 33604-2852 |
Second Address | Tampa, FL 33604-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L523000825290 | CAR INSURANCE (01) | FL |