Healthcare Provider Details

I. General information

NPI: 1083687917
Provider Name (Legal Business Name): CARLOS E. DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 N KENDALL DR SUITE 105
MIAMI FL
33176-2212
US

IV. Provider business mailing address

8740 N KENDALL DR SUITE 105
MIAMI FL
33176-2212
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-2080
  • Fax: 305-270-2012
Mailing address:
  • Phone: 305-270-2080
  • Fax: 305-270-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME0050223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: