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General NPI Number Information
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NPI Number | 1548579899
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Entity Type | Organization
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Legal Business Name | HERNAN DIAZ-BOLANO MD PA
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 9621 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-4030
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Country | US
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Telephone | 786-394-3429
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Fax | 305-503-8545
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Provider Business Mailing Address
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Address Line | 8200 MILLER DR
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City | MIAMI
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State | FL
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Zip | 33155-5423
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Country | US
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Telephone | 786-294-3429
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Fax | 305-503-8545
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HERNAN DIAZ-BOLANO
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Credential | M.D.
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Telephone | 786-394-3429
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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 | 44883
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License Number State | FL
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