Provider Demographics
NPI:1033215546
Name:DIAZ-RAMIREZ, MYRDALIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRDALIS
Middle Name:
Last Name:DIAZ-RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRDALIS
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3230 SOUTHGATE CIR STE 139
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5514
Mailing Address - Country:US
Mailing Address - Phone:941-557-7242
Mailing Address - Fax:941-557-7242
Practice Address - Street 1:1958 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2217
Practice Address - Country:US
Practice Address - Phone:941-557-7242
Practice Address - Fax:941-557-7241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96703207L00000X, 207LP2900X, 202D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262271800Medicaid
FL262271800Medicaid
FL03048ZMedicare PIN
FL03048YMedicare PIN