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General NPI Number Information
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NPI Number | 1760678510
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Entity Type | Individual
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Provider Name | JOSE A DIAZ PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 4200 SW 152ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-3363
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Country | US
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Telephone | 954-430-3019
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Fax | 954-431-0617
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Provider Business Mailing Address
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Address Line | 4200 SW 152ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-3363
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Country | US
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Telephone | 954-430-3019
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Fax | 954-431-0617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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