Provider Demographics
NPI:1245220276
Name:DIAZ-YOSEREV, RAFAEL (MD, FACS)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:DIAZ-YOSEREV
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7274
Mailing Address - Country:US
Mailing Address - Phone:305-444-6100
Mailing Address - Fax:305-448-8982
Practice Address - Street 1:3211 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7274
Practice Address - Country:US
Practice Address - Phone:305-444-6100
Practice Address - Fax:305-448-8982
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0034947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63602Medicare UPIN
FL95763AMedicare ID - Type Unspecified