=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063757698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GIULIANA DIAZ JONES D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2012
-----------------------------------------------------
Last Update Date | 11/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5070 HIGHWAY A1A SUITE E
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32963-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-234-5353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5070 HIGHWAY A1A STE E
-----------------------------------------------------
City | INDIAN RIVER SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32963-1229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-234-5353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DN 19871
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------