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General NPI Number Information
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NPI Number | 1790431260
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Entity Type | Individual
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Provider Name | JENNIFER DIAZ
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 333 1ST ST STE A
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-2661
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 8805 NW 162ND TER
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City | HIALEAH
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State | FL
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Zip | 33018-6303
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Country | US
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Telephone |
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11018325
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 433197
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95033652
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License Number State | CA
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