Healthcare Provider Details

I. General information

NPI: 1912768268
Provider Name (Legal Business Name): AINEL LOY DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 NE 2ND ST
HALLANDALE BEACH FL
33009-3561
US

IV. Provider business mailing address

708 NE 2ND ST
HALLANDALE BEACH FL
33009-3561
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-6169
  • Fax:
Mailing address:
  • Phone: 545-446-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17485I
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number258436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: