MEDICARE: DR. KEYLA DIAZ - MEDINA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ACN1152	FL
2	208D00000X	General Practice Physician	14586	PR

General Provider Information

NPI Number	:	1124221593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEYLA DIAZ - MEDINA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25487
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2487
Country	:	US
Telephone Number	:	941-216-0072
Fax Number	:	877-807-0253

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD STE 20
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3334
Country	:	US
Telephone Number	:	954-368-4560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	12/09/2025

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