Healthcare Provider Details

I. General information

NPI: 1205456845
Provider Name (Legal Business Name): BLANCA IRENE DIAZ GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 203
MIAMI FL
33155-4070
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8380
  • Fax: 866-832-5324
Mailing address:
  • Phone: 305-386-7420
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME163332
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME163332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: