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General NPI Number Information
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NPI Number | 1790143972
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Entity Type | Organization
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Legal Business Name | LUIS A. DIAZ-SECADES, MD, PA
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 11880 BIRD RD SUITE 210
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City | MIAMI
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State | FL
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Zip | 33175-3584
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Country | US
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Telephone | 305-559-0211
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Fax | 305-559-0966
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Provider Business Mailing Address
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Address Line | 10455 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7060
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Country | US
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Telephone | 305-559-0211
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Fax | 305-559-0966
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LUIS A DIAZ SECADES
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Credential | MD
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Telephone | 305-559-0211
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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 | ME-4129
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License Number State | FL
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