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General NPI Number Information
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NPI Number | 1306487202
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Entity Type | Organization
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Legal Business Name | AURORA MEDICAL GROUP. CORP
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1419 W WATERS AVE STE 106
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City | TAMPA
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State | FL
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Zip | 33604-2896
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Country | US
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Telephone | 813-444-1600
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Fax | 813-295-8029
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Provider Business Mailing Address
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Address Line | 1419 W WATERS AVE STE 106
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City | TAMPA
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State | FL
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Zip | 33604-2896
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Country | US
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Telephone | 813-444-1600
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Fax | 813-295-8029
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANISLEY LANZA DIAZ
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Credential | RN, BSN, MSN
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Telephone | 813-403-2567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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