Provider Demographics
NPI:1477889244
Name:DIAZ, JESUS MARIO JR (HEARING AID SPECIALI)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MARIO
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:HEARING AID SPECIALI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3057
Mailing Address - Country:US
Mailing Address - Phone:786-303-0876
Mailing Address - Fax:305-556-4505
Practice Address - Street 1:3320 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3057
Practice Address - Country:US
Practice Address - Phone:786-303-0876
Practice Address - Fax:305-556-4505
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4280174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator