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1861969883 NPI number — BORIS D DIEZ APRN

NPI Number: 1861969883
Health Care Provider/Practitioner: BORIS D DIEZ APRN

Information about “1861969883” NPI (BORIS D DIEZ APRN) exists in 1861969883 in HTML format HTML  |  1861969883 in plain Text format TXT  |  1861969883 in PDF (Portable Document Format) PDF  |  1861969883 in an XML format XML  formats.

NPI Number : 1861969883 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861969883",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIEZ",
    "FirstName": "BORIS",
    "MiddleName": "D",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16881 SW 278TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOMESTEAD",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33031-2745",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-253-9513",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1414 NW 107TH AVE STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SWEETWATER",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33172-2741",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "786-253-9513",
    "PracticeLocationAddressFaxNumber": "786-933-6651",
    "EnumerationDate": "10/29/2018",
    "LastUpdateDate": "12/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "APRN11000018",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN11000018",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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