Healthcare Provider Details

I. General information

NPI: 1780707760
Provider Name (Legal Business Name): DIAZ & SIDRON MEDICAL DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 NW 7TH ST SUITE 490
MIAMI FL
33126-3422
US

IV. Provider business mailing address

5040 NW 7TH ST SUITE 490
MIAMI FL
33126-3422
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-9245
  • Fax: 305-444-9246
Mailing address:
  • Phone: 305-444-9245
  • Fax: 305-444-9246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDUARDO DIAZ
Title or Position: PRESIDENT
Credential: MD
Phone: 786-385-2814