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General NPI Number Information
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NPI Number | 1366878829
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA PREVENTIVE CARE GROUP
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 19015 NW 80TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-5210
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Country | US
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Telephone | 305-934-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 19015 NW 80TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-5210
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Country | US
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Telephone | 305-934-7076
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Fax |
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Authorized Official
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Title or Position | DNP
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Name | DR. DEISY DIAZ-PRIETO
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Credential | DNP
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Telephone | 305-934-7076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9179779
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License Number State | FL
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