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General NPI Number Information
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NPI Number | 1235370289
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Entity Type | Individual
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Provider Name | GERARDO DIAZ M.D
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Gender | Male
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 14201 S DIXIE HWY
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7224
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Country | US
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Telephone | 786-227-6396
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Fax | 786-227-6456
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Provider Business Mailing Address
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Address Line | 22112 SW 130TH CT
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City | MIAMI
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State | FL
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Zip | 33170-2694
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Country | US
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Telephone | 305-978-6309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME103459
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 103459
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License Number State | FL
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