Healthcare Provider Details

I. General information

NPI: 1659360998
Provider Name (Legal Business Name): CANDIDO DIAZ-CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 407
MIAMI FL
33133-4236
US

IV. Provider business mailing address

3661 S MIAMI AVE SUITE 407
MIAMI FL
33133-4236
US

V. Phone/Fax

Practice location:
  • Phone: 305-860-8808
  • Fax:
Mailing address:
  • Phone: 305-860-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME0025369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: