Healthcare Provider Details

I. General information

NPI: 1295014348
Provider Name (Legal Business Name): MANUEL DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 DEL PRADO BLVD S STE 103
CAPE CORAL FL
33990-3627
US

IV. Provider business mailing address

923 DEL PRADO BLVD S STE 103
CAPE CORAL FL
33990-3627
US

V. Phone/Fax

Practice location:
  • Phone: 239-456-0196
  • Fax: 239-456-0216
Mailing address:
  • Phone: 239-456-0196
  • Fax: 239-456-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01093819A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: