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General NPI Number Information
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NPI Number | 1427355221
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Entity Type | Organization
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Legal Business Name | DIAZ JANE OB GYN PA
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 777 E 25TH ST SUITE 201
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 305-822-8123
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Fax | 305-822-0628
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Provider Business Mailing Address
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Address Line | 777 E 25TH ST SUITE 201
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 305-822-8123
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Fax | 305-822-0628
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | JULIO ANDRES DIAZ-JANE
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Credential | M,D
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Telephone | 305-822-8123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME41208
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License Number State | ZZ
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