Provider Demographics
NPI:1033745120
Name:DIAZ ABREU, JEIMY YSABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEIMY
Middle Name:YSABEL
Last Name:DIAZ ABREU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 SW 36TH TER UNIT 1
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7404
Mailing Address - Country:US
Mailing Address - Phone:786-209-9273
Mailing Address - Fax:
Practice Address - Street 1:560 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3776
Practice Address - Country:US
Practice Address - Phone:352-259-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN249881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program