Healthcare Provider Details

I. General information

NPI: 1124548763
Provider Name (Legal Business Name): LUIS RUBEN DIAZ-PAEZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152 ST EMERGENCY DEPARTMENT
MIAMI FL
33157
US

IV. Provider business mailing address

10861 SW 128TH ST
MIAMI FL
33176-5442
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 786-763-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9410772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: