1033274014 NPI number — EDUARDO DIAZ, MD PA

Table of content: (NPI 1033274014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033274014 NPI number — EDUARDO DIAZ, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDUARDO DIAZ, MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033274014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14520 SW 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33184-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-485-9986
Provider Business Mailing Address Fax Number:
305-267-3463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5703 NW 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-267-3462
Provider Business Practice Location Address Fax Number:
305-267-3463
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-267-3462

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME88639 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004953700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com