Healthcare Provider Details

I. General information

NPI: 1932355138
Provider Name (Legal Business Name): DORIS DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORIS DIAZ DE LA TORRE MD

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15507 NW 67TH AVE
MIAMI LAKES FL
33014-2108
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-8611
  • Fax: 305-827-1753
Mailing address:
  • Phone: 305-821-8611
  • Fax: 305-827-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 101131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: