Healthcare Provider Details

I. General information

NPI: 1144799156
Provider Name (Legal Business Name): FLORA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W 44TH PL
HIALEAH FL
33012-7405
US

IV. Provider business mailing address

1716 W 44TH PL
HIALEAH FL
33012-7405
US

V. Phone/Fax

Practice location:
  • Phone: 786-443-0007
  • Fax:
Mailing address:
  • Phone: 786-443-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number130269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: