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General NPI Number Information
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NPI Number | 1053795815
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Entity Type | Organization
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Legal Business Name | DIAZ MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 07/11/2015
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Last Update Date | 07/11/2015
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Provider Practice Location Address
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Address Line | 303 BRYAN RD SUITE 1
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City | BRANDON
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State | FL
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Zip | 33511-5342
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Country | US
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Telephone | 813-684-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 303 BRYAN RD SUITE 1
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City | BRANDON
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State | FL
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Zip | 33511-5342
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Country | US
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Telephone | 813-684-6867
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAMELA RUESCH
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Credential | BS
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Telephone | 813-385-8089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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