MEDICARE: MS. YAMILA DIEZ DO

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	156FX1800X	Optician	DO6881	FL

General Provider Information

NPI Number	:	1700510823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YAMILA DIEZ DO

Provider Business Mailing Address
First Line	:	2031 SW 103RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-7319
Country	:	US
Telephone Number	:	305-414-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 NW N RVR DR STE 355
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-2894
Country	:	US
Telephone Number	:	305-414-3020
Fax Number	:

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

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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