Provider Demographics
NPI:1477508430
Name:DIAZ, SONIA (DO)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4408
Mailing Address - Country:US
Mailing Address - Phone:786-243-4100
Mailing Address - Fax:786-243-4111
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:1A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-703-3484
Practice Address - Fax:786-703-3486
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3184207Q00000X
TN3027207Q00000X
VA0102204749207Q00000X
NH17984207Q00000X
ARE-10124207Q00000X
DCDO034606207Q00000X
GA077124207Q00000X
SC40253207Q00000X
KY04059207Q00000X
NC2016-02010207Q00000X
OH34.012435207Q00000X
FLOS9473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275372300Medicaid
FL275372300Medicaid
FLAE851XMedicare PIN