Provider Demographics
NPI:1205184769
Name:DIAZ, ORLANDO
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NW 79TH AVE STE 455A
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6548
Mailing Address - Country:US
Mailing Address - Phone:305-994-7599
Mailing Address - Fax:305-994-7455
Practice Address - Street 1:3900 NW 79TH AVE STE 455A
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6548
Practice Address - Country:US
Practice Address - Phone:305-994-7599
Practice Address - Fax:305-994-7455
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study