Healthcare Provider Details

I. General information

NPI: 1053724997
Provider Name (Legal Business Name): ELIZABETH DIAZ GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

IV. Provider business mailing address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

V. Phone/Fax

Practice location:
  • Phone: 786-243-8073
  • Fax:
Mailing address:
  • Phone: 786-243-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME132319
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31022R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: