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General NPI Number Information
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NPI Number | 1861969883
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Entity Type | Individual
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Provider Name | BORIS D DIEZ APRN
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Gender | Male
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE STE 205
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City | SWEETWATER
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State | FL
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Zip | 33172-2741
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Country | US
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Telephone | 786-253-9513
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Fax | 786-933-6651
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Provider Business Mailing Address
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Address Line | 16881 SW 278TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33031-2745
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Country | US
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Telephone | 786-253-9513
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN11000018
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11000018
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License Number State | FL
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