Healthcare Provider Details

I. General information

NPI: 1841882016
Provider Name (Legal Business Name): GENIEL ALBERTO DIAZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 POOLE RD STE 120
RALEIGH NC
27610-2918
US

IV. Provider business mailing address

PO BOX 746724
ATLANTA GA
30374-6724
US

V. Phone/Fax

Practice location:
  • Phone: 919-902-7366
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005640
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: