Provider Demographics
NPI:1326000555
Name:DIAZ, PEDRO JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JOAQUIN
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 NW 2ND AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5501
Mailing Address - Country:US
Mailing Address - Phone:305-654-3718
Mailing Address - Fax:
Practice Address - Street 1:16800 NW 2ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5501
Practice Address - Country:US
Practice Address - Phone:305-654-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260986000Medicaid
FLE5924Medicare UPIN
FL260986000Medicaid