Healthcare Provider Details

I. General information

NPI: 1982807996
Provider Name (Legal Business Name): NELLY DIAZ-MENDEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DR SUITE 109
MIAMI FL
33176-1044
US

IV. Provider business mailing address

10026 HAMMOCKS BLVD APT 105
MIAMI FL
33196-3766
US

V. Phone/Fax

Practice location:
  • Phone: 786-621-0494
  • Fax: 786-263-0004
Mailing address:
  • Phone: 305-336-1540
  • Fax: 305-752-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9210659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: