Healthcare Provider Details

I. General information

NPI: 1518204726
Provider Name (Legal Business Name): ISMARAY DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

8600 SW 92ND ST STE 204B
MIAMI FL
33156-7377
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-5999
  • Fax:
Mailing address:
  • Phone: 305-562-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN11018362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: