Provider Demographics
NPI:1346963113
Name:DIAZ, XIOMARA (RPH)
Entity Type:Individual
Prefix:MS
First Name:XIOMARA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20345 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1831
Mailing Address - Country:US
Mailing Address - Phone:305-232-9130
Mailing Address - Fax:
Practice Address - Street 1:20345 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1831
Practice Address - Country:US
Practice Address - Phone:305-232-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist