Healthcare Provider Details

I. General information

NPI: 1871863530
Provider Name (Legal Business Name): ANA DIAZ-GONZALEZ DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9159 SW 87TH AVE
MIAMI FL
33176-2302
US

IV. Provider business mailing address

9159 SW 87TH AVE
MIAMI FL
33176-2302
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-2499
  • Fax: 305-279-6647
Mailing address:
  • Phone: 305-279-2499
  • Fax: 305-279-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3471
License Number StateFL

VIII. Authorized Official

Name: ANA DIAZ-GONZALEZ
Title or Position: OWNER
Credential: DPM
Phone: 305-279-2499