Healthcare Provider Details

I. General information

NPI: 1033274014
Provider Name (Legal Business Name): EDUARDO DIAZ, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 NW 7TH ST
MIAMI FL
33126-3105
US

IV. Provider business mailing address

14520 SW 9TH ST
MIAMI FL
33184-3118
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-3462
  • Fax: 305-267-3463
Mailing address:
  • Phone: 305-485-9986
  • Fax: 305-267-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88639
License Number StateFL

VIII. Authorized Official

Name: DR. EDUARDO DIAZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-267-3462