MEDICARE: DIAZ HEALTHCARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1538950753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAZ HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	923 DEL PRADO BLVD S STE 103
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3627
Country	:	US
Telephone Number	:	239-456-0196
Fax Number	:	239-456-0216

Provider Business Practice Location Address
First Line	:	923 DEL PRADO BLVD S STE 103
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3627
Country	:	US
Telephone Number	:	239-456-0196
Fax Number	:	239-456-0216

Authorized Official
Title or Position	:	M.D.
Name	:	MANUEL DIAZ
Credential	:	MD
Telephone Number	:	239-456-0196

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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