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General NPI Number Information
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NPI Number | 1598518128
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Entity Type | Organization
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Legal Business Name | JORGE L. DIAZ D.O P.A
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 126 E 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-1853
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Country | US
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Telephone | 305-786-7536
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Fax | 305-821-9050
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Provider Business Mailing Address
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Address Line | 7100 W 20TH AVE STE 401
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City | HIALEAH
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State | FL
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Zip | 33016-1811
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Country | US
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Telephone | 305-821-6112
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Fax | 305-821-9050
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | JORGE GARCIA
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Credential |
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Telephone | 305-606-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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