Healthcare Provider Details

I. General information

NPI: 1194646349
Provider Name (Legal Business Name): ANDRES ALEJANDRO DE NOVI DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

501 N DIXIE HWY STE 1007
HALLANDALE BEACH FL
33009-3986
US

IV. Provider business mailing address

20600 NE 2ND CT
MIAMI FL
33179-2992
US

V. Phone/Fax

Practice location:
  • Phone: 954-736-7300
  • Fax:
Mailing address:
  • Phone: 954-647-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: