Healthcare Provider Details

I. General information

NPI: 1629568340
Provider Name (Legal Business Name): DERRICK HENRY DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E 8TH AVE
HIALEAH FL
33010-5116
US

IV. Provider business mailing address

5800 SW 122ND AVE
MIAMI FL
33183-1510
US

V. Phone/Fax

Practice location:
  • Phone: 305-716-2186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME134444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: