Provider Demographics
NPI:1326743113
Name:DIAZ, LUZ (PA)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OAXACA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7019
Mailing Address - Country:US
Mailing Address - Phone:407-431-4831
Mailing Address - Fax:
Practice Address - Street 1:401 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5750
Practice Address - Country:US
Practice Address - Phone:407-821-3655
Practice Address - Fax:407-821-3656
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117265363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical