Healthcare Provider Details

I. General information

NPI: 1033215546
Provider Name (Legal Business Name): MYRDALIS DIAZ-RAMIREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRDALIS DIAZ MD

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 PROSPECT ST
SARASOTA FL
34239-2217
US

IV. Provider business mailing address

3230 SOUTHGATE CIR STE 139
SARASOTA FL
34239-5514
US

V. Phone/Fax

Practice location:
  • Phone: 941-557-7242
  • Fax: 941-557-7241
Mailing address:
  • Phone: 941-557-7242
  • Fax: 941-557-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME96703
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME96703
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberME96703
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME96703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: