Provider Demographics
NPI:1124221593
Name:DIAZ - MEDINA, KEYLA (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYLA
Middle Name:
Last Name:DIAZ - MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3C53 CALLE FERRARA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-7027
Mailing Address - Country:US
Mailing Address - Phone:787-645-9010
Mailing Address - Fax:
Practice Address - Street 1:3700 WASHINGTON ST STE 500B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8259
Practice Address - Country:US
Practice Address - Phone:954-967-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14586208D00000X
FLACN1152208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice