Active NPI
Angela Diaz-Vidaillet
- Mental Health Counselor
- Miami Shores, FL
National Provider Identifier
1427717255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH2353
- Practice address
- 65 NW 107TH St
Miami Shores, FL 33168-4306 - Phone
- (305) 542-4128
- NPI assigned
- Dec 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Mental Health Counselor | 101YM0800X | MH2353 | FL | Primary |
Addresses
Primary practice location
65 NW 107TH St
Miami Shores, FL 33168-4306
Mailing address
65 NW 107TH St
Miami Shores, FL 33168-4306
Phone (305) 542-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH2353 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639008000000",
"number": "1427717255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 NW 107TH ST",
"city": "MIAMI SHORES",
"state": "FL",
"postal_code": "331684306",
"telephone_number": "305-542-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 NW 107TH ST",
"city": "MIAMI SHORES",
"state": "FL",
"postal_code": "331684306",
"telephone_number": "305-542-4128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ-VIDAILLET",
"first_name": "ANGELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-09",
"last_updated": "2021-12-09",
"certification_date": "2021-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH2353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami Shores, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.