MEDICARE: ELENA B DIAZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP2509622	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316922156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA B DIAZ CRNA

Provider Business Mailing Address
First Line	:	9333 SW 152ND ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-1778
Country	:	US
Telephone Number	:	305-256-5267
Fax Number	:

Provider Business Practice Location Address
First Line	:	9333 SW 152ND ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-1778
Country	:	US
Telephone Number	:	305-256-5267
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	05/27/2016

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