Healthcare Provider Details

I. General information

NPI: 1972866291
Provider Name (Legal Business Name): RAFAEL EUDARDO FRANJUL DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 SUN N LAKE BLVD STE A
SEBRING FL
33872-2131
US

IV. Provider business mailing address

4145 SUN N LAKE BLVD STE A
SEBRING FL
33872-2131
US

V. Phone/Fax

Practice location:
  • Phone: 863-546-0030
  • Fax: 702-369-3664
Mailing address:
  • Phone: 863-546-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17181
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME148282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: