=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497637029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVETTE DIAZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8900 SW 24TH ST STE 100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9511
-----------------------------------------------------
Fax | 305-229-9112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8900 SW 24TH ST STE 100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-9511
-----------------------------------------------------
Fax | 305-229-9112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | HCC4575
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------