Healthcare Provider Details

I. General information

NPI: 1871800664
Provider Name (Legal Business Name): JULIAN DIAVANTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W 49TH ST STE 404
HIALEAH FL
33012-2978
US

IV. Provider business mailing address

1840 W 49TH ST STE 404
HIALEAH FL
33012-2978
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-9980
  • Fax: 786-507-4734
Mailing address:
  • Phone: 786-303-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME108115
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME108115
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME108115
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME108115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: