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General NPI Number Information
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NPI Number | 1407444730
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Entity Type | Organization
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Legal Business Name | DIEZ MEDICAL LLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE STE 205
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City | SWEETWATER
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State | FL
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Zip | 33172-2741
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Country | US
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Telephone | 786-253-9513
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Fax | 786-933-6651
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Provider Business Mailing Address
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Address Line | 16881 SW 278TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33031-2745
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Country | US
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Telephone | 786-253-9513
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BORIS D DIEZ
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Credential | APRN
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Telephone | 786-253-9513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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