MEDICARE: FARAH A DIAZ DDS

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	DN20362	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

General Provider Information

NPI Number	:	1861784779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARAH A DIAZ DDS

Provider Business Mailing Address
First Line	:	2301 SW 16TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3927
Country	:	US
Telephone Number	:	786-619-5393
Fax Number	:	305-541-0333

Provider Business Practice Location Address
First Line	:	750 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3817
Country	:	US
Telephone Number	:	305-694-5400
Fax Number	:	305-541-0333

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

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	08/21/2013

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