Healthcare Provider Details

I. General information

NPI: 1255733325
Provider Name (Legal Business Name): FERNANDO DIEZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 CORAL WAY STE 102
MIAMI FL
33155-6539
US

IV. Provider business mailing address

7805 CORAL WAY STE 102
MIAMI FL
33155-6539
US

V. Phone/Fax

Practice location:
  • Phone: 305-261-4119
  • Fax: 305-261-4153
Mailing address:
  • Phone: 305-261-4119
  • Fax: 305-261-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME32678
License Number StateFL

VIII. Authorized Official

Name: DR. FERNANDO JULIAN DIEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-261-4119