Healthcare Provider Details

I. General information

NPI: 1366483828
Provider Name (Legal Business Name): EDUARDO DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 NW 7TH ST
MIAMI FL
33126-3105
US

IV. Provider business mailing address

3401 SW 130TH AVE
MIAMI FL
33175-2723
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-3462
  • Fax: 305-267-3463
Mailing address:
  • Phone: 786-385-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88639
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME88639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: