Provider Demographics
NPI:1104798495
Name:DIANA, LETICIA M (AP)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:M
Last Name:DIANA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CORAL WAY # 352
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3438
Mailing Address - Country:US
Mailing Address - Phone:786-624-0794
Mailing Address - Fax:
Practice Address - Street 1:4014 CHASE AVE STE PH1
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3452
Practice Address - Country:US
Practice Address - Phone:786-624-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty