1235240649 NPI number — LAWRENCE A DIAZ R.PH.

Table of content: LAWRENCE A DIAZ R.PH. (NPI 1235240649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235240649 NPI number — LAWRENCE A DIAZ R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
LAWRENCE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
M

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:
1235240649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3914 SW 102ND WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32607-4658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-332-0649
Provider Business Mailing Address Fax Number:
352-331-5041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32693-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-463-2240
Provider Business Practice Location Address Fax Number:
352-463-1645
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS12049 , 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: PS12049 . This is a "LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com