Healthcare Provider Details

I. General information

NPI: 1972294544
Provider Name (Legal Business Name): JOHAN M DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2053
  • Fax:
Mailing address:
  • Phone: 305-674-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME180996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: