MEDICARE: DR. STEPHANIE DIAZ

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	1223G0001X	General Practice Dentistry	DN16700	FL

General Provider Information

NPI Number	:	1437260148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE DIAZ

Provider Business Mailing Address
First Line	:	494 NW 107TH TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7928
Country	:	US
Telephone Number	:	954-796-8097
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-4180
Country	:	US
Telephone Number	:	954-755-1222
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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