Healthcare Provider Details

I. General information

NPI: 1699773192
Provider Name (Legal Business Name): DIAZ & DIAZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST
TRENTON FL
32693-3438
US

IV. Provider business mailing address

220 N MAIN ST
TRENTON FL
32693-3438
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-2240
  • Fax: 352-463-1645
Mailing address:
  • Phone: 352-463-2240
  • Fax: 352-463-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH8822
License Number StateFL

VIII. Authorized Official

Name: MR. LAWRENCE A DIAZ
Title or Position: PRESIDENT
Credential: RPH
Phone: 352-463-2240