Provider Demographics
NPI:1295466571
Name:DIAZ-MARIN, SAUL ENMANUEL (APRN)
Entity Type:Individual
Prefix:MR
First Name:SAUL
Middle Name:ENMANUEL
Last Name:DIAZ-MARIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:SAUL
Other - Middle Name:ENMANUEL
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3742
Mailing Address - Country:US
Mailing Address - Phone:786-470-9887
Mailing Address - Fax:
Practice Address - Street 1:4225 S LEE ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3658
Practice Address - Country:US
Practice Address - Phone:770-727-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP000820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily