Healthcare Provider Details

I. General information

NPI: 1902717499
Provider Name (Legal Business Name): JUAN DIAZ II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SW 37TH ST
GAINESVILLE FL
32607-4442
US

IV. Provider business mailing address

1720 SW 37TH ST
GAINESVILLE FL
32607-4442
US

V. Phone/Fax

Practice location:
  • Phone: 786-868-8983
  • Fax:
Mailing address:
  • Phone: 786-868-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberD200-423-07-096-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: