MEDICARE: ANTONIO FAUSTO DIAZ ARNP

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	104100000X	Social Worker
2	363LF0000X	Family Nurse Practitioner	ARNP9373483	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831423466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO FAUSTO DIAZ ARNP

Provider Business Mailing Address
First Line	:	16622 SW 71ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5533
Country	:	US
Telephone Number	:	305-397-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	16622 SW 71ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5533
Country	:	US
Telephone Number	:	305-397-5951
Fax Number	:	305-397-5951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	03/17/2018

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